by publius
I missed the latest round of the “should we sell our kidneys” debate. To recap, various libertarian conservatives say yes, arguing that the donors’ health risks are small and that people really need kidneys. The real challenge then, as John Schwenkler notes, is to justify the ban on kidney selling.
So I’ll try. I’m not sure I can justify the actual ban – I lack the philosophical chops. But I can get in the neighborhood, and maybe someone in the comments can punch it over the goal line.
The kidney debate interests me because it touches upon a much deeper and fundamental philosophical divide between modern progressives and conservatives (particularly libertarians). The divide turns on one’s view of markets and, more precisely, freedom. This divide, I think, is the original source of disagreement on several issues, particularly health coverage reform and labor law.
Modern libertarians subscribe to the old classic liberal worldview. Under this view, there is a heavy emphasis on individual freedom. Markets free from government intervention are good because they allow people to freely exchange goods, enter contracts, and generally do what they want – which has numerous benefits (efficient allocations, etc.). The underlying assumption is that people can indeed act freely within this system.
One of the main critiques, however, of (classical) liberalism is that this underlying assumption is unrealistic, or even fraudulent. It’s absurd, the argument goes, to treat people as being "free" within markets – to assume they are islands of self-contained free will exercising their rights equally.
The truth, critics argue, is that “free” markets obscure vast disparities in wealth, power, information, bargaining position, etc. In this sense, the assumption of “freedom” is a helpful ideology, but not one that accurately describes the relative power of contracting parties.
Here’s an example. Let’s say Wal-Mart decides to start offering people $5,000 per finger. (Let’s assume scientists have found a chemical in finger bones that helps break unions). Under the liberal view, everyone is “free” to take that offer or to decline it.
But this “freedom” isn’t all it’s cracked up to be. From an opportunity cost perspective, Wal-Mart’s offer exerts more force on someone with a salary of $25,000, than it does on someone who makes $100,000. The former is essentially throwing away 20% of their yearly salary, while the latter is throwing away 5%. Both individuals are “free” – but the lower income makes the offer harder to refuse for the $25K person. It exerts more force on that person. To say, then, that these two people are both “free” misses an important difference between them.
Of course, you can take this logic to some dangerous and absurd extremes. You could, for instance, argue that Big Macs should be priced according to one’s income, or that various types of markets (e.g., house cleaning) should be prohibited. But these are not things I want government to do. I believe in markets, not necessarily because I completely buy the idea of “freedom,” but because I am skeptical that the government is competent to address these problems through central planning, extreme redistribution, etc. The remedies are often worse than the problems.
But that said, there are areas where we need to draw the line on markets. Just as liberalism’s goal was to carve out a realm of freedom from the state, it’s also important to carve out realms of freedom from coercive market logic.
Market failures are a different issue. I’m sure a market for kidneys would work pretty well. I’m just not sure I want market logic – which is necessarily coercive on some more than others – to intrude into the realm of body parts, or selling children.
At the end of the day, I’m not sure any of this is helpful. I’ve basically said “there should be a line,” but I haven’t established whether kidney selling crosses that line. Maybe someone else can. But this hopefully at least explains where some liberals are coming from – not just on this issue, but on a whole host of political issues.
The skepticism that everyone is free under classic liberalism is one of the foundational assumptions that leads me to root viscerally (often too viscerally) for progressive policies. It also makes me relatively more inclined to favor regulation in certain contexts.
At the end of the day, I guess I feel similarly to Kevin Drum – it’s not so much kidneys that bother me. It’s that I can easily imagine this logic spreading to things like eyes, or even children. I can’t quite justify it, but the inherent coercion on poorer people seems like a bigger deal when we start trying to commodify body parts. If only we had a real philosopher who blogged here….
Publius – Somin and McArdle are libertarians, not conservatives. (I don’t know about Schwenkler, although he only says that he’s open to the debate — not that he necessariy favors organ sales of the kind proposed by Somin or McArdle.)
i actually had that first, but i wasn’t exactly sure how to classify Schwenkler. So i left it as conservative. but it’s probably imprecise, so i’ll tweak
So far it sounds like it boils down to “We shouldn’t do fetal stem cell research because it is gross and wrong”. Oh, I mean sell kidneys.
“At the end of the day, I guess I feel similarly to Kevin Drum – it’s not so much kidneys that bother me. It’s that I can easily imagine this logic spreading to things like eyes, or even children.”
It isn’t so much the idea of experimenting on 10 day old fetal cells that bothers me, it is that I can easily imagine this logic spreading to things like 8 month old fetuses, or full grown clones.
Actually, now that I’ve done this exercise–since I’m mildly nervous about fetal stem cell research, I sort of get your kidney objections more.
Funny, I just smacked myself with my own argument.
Very thoughtful.
Occurs to me that all markets are coersive by their very definition, so are you not arguing that the level of coersiveness is the problem?
We already allow people to sell blood. Of course that isn’t permanent, but it does muddy the water of selling human ‘parts’, depending upon ones definition.
Maybe the line should be about stuff a fully functional, healthy human doesn’t necessarily need – like the second kidney…
Though I don’t want to be on the ethics committee when somebody who sold one kidney discovers the other one is failing and wants a transplant.
The ultimate free market in labor is slavery (excuse me, indentured servitude). This country has decided to ban that idea. Even personal assistants must have their income declared to the IRS.
A pint of blood, on the other hand, can be taken about once every two months without any apparent detriment to the donor.
My personal take is that kidney sales are closer to slavery than blood donation. It’s a commodification of an essential and irreplaceable aspect of bodily integrity. I’m profoundly concerned by the possible secondary consequences that could arise from the viewpoint that these kinds of transactions are acceptable. (can you buy an option in a kidney, to be exercised at a future date? what happens if the donor changes his mind? etc.)
Yes, kidney selling can save lives and relieve poverty. So can slavery. Some societal values outweigh the life of a single individual.
Uncle Joe would agree.
TDSWJS last night had an hilariously pointed segment with John Hodgman on this very issue…
I’m not a REAL philosopher, only a political one, but a couple of real philosophers have weighed in on this issue, sort of.
The father of market economics, Adam Smith, was a moral philosopher by trade (there were no economists back then as he had just invented the discipline) and he argued in Wealth of Nations that certain goods were too precious to human life to be left in the hands of the markets. Human greed could be a good thing under some circumstances according to Smith but certain vital items had to be protected from that greed. Kidney’s would, I think, fall into that category for Smith.
Mill touched on the slavery issue, i.e. whether it was morally permissible for a person to willingly sell themselves into slavery. He determined that it was morally equivalent to suicide and thus it was one of the realms where society was justified in intervening and limiting personal freedom. The permanence and the potential for harm, thus limiting one’s own future freedom which is what Mill was concerned with, would seem to make Kidney sales a moral equivalent to slavery or suicide for Mill.
Hope that was helpful.
CharlesWT wrote:
“Under the liberal view, everyone is “free” to take that offer or to decline it.”
Do you mean “libertarian?”
No, he’s referring to classical liberalism or the liberalism of John Locke and John Stewart Mill. Libertarianism is in some ways similar but it tends to be classical liberalism without the common sense, or at least that’s the way it seems to me.
Libertarians, schmibertarians.
Under a libertarian regime, those requiring a kidney from a donor would be dead before they found the donor because they wouldn’t receive the interim subsidized dialysis from our “Socialist” healthcare system.
Case closed.
So where do parents who have (or use) a second child in order to provide donor material for an ill child fall into this?
Occurs to me that all markets are coersive by their very definition, so are you not arguing that the level of coersiveness is the problem?
I don’t get this comment on any level. Markets are not “coercive by their very definition.” By definition, a market is an exchange in which a willing buyer and a willing seller mutually agree upon a transaction. Where is the coercion? That you are not free to steal eggs instead of paying for them?
Debra Satz, a political philosopher at Stanford, has done a lot of work on “toxic markets”–see, e.g., her recent “Voluntary Slavery and the Limits of Markets.”
(Sorry for no links, but the Stanford server is being slow, so I can’t get to her home page. In any event, some of her papers can easily be found by googling her name.)
My personal take is that kidney sales are closer to slavery than blood donation. It’s a commodification of an essential and irreplaceable aspect of bodily integrity.
Just like forcing a woman through pregnancy and childbirth against her will. Yeah.
I didn’t know that John Stuart Mills had made that analogy about slavery and suicide, but I’d go with it. Something to do with your own body ought to be your own free choice. (For this reason, I also oppose making it legal to hire a woman for surrogate pregnancy: same deal.)
So where do parents who have (or use) a second child in order to provide donor material for an ill child fall into this?
I tend to think bone marrow donation is a bit different – like blood donation, it’s doesn’t do any long-term damage. I would absolutely oppose parents making the decision that a minor child ought to “donate” an irreplacable organ to a sibling. (If we can leave out special cases like conjoined twins with only one set of organs between them – and even then: I think in sheer humanity the decisions about separation and survival ought to be made on a purely medical basis.)
“Occurs to me that all markets are coersive by their very definition, so are you not arguing that the level of coersiveness is the problem?”
If you are going to take this level of abstraction, all human actions that effect other people end up being coercive. Family interactions? Definitely coercive. Charitable giving with strings? Definitely coercive. Charitable giving with implied expectations? Coercive.
You’ve essentially emptied the word ‘coercive’ of its meaning.
(I would argue that the system of family obligations seen even in many 1st world families and definitely in all other families is far more coercive than most markets.)
We already allow people to sell blood.
Not whole blood for transfusion, we don’t. Only plasma donors can be paid.
Sebastian: I would argue that the system of family obligations seen even in many 1st world families and definitely in all other families is far more coercive than most markets.
Can be, in abusive families, certainly. Or in families which assume economic dependence well after the age of majority.
But I feared losing my job because I came out a lot more than I feared losing my family because I came out. If I’d lost my job I could have lost my home: if I lost my family, well… as a friend once drily noted, coming out after you’re economically independent of your parents means they need you more than you need them. (Coming out while still economically dependent on parents can still be a complete horror, though.)
The problem with unrestricted markets is that they ultimately reward the people who can get away with stealing the eggs. Publius’ point was that buyers and sellers are often limited by their material circumstances and positions within the market – people with less content knowledge, less know-how, less social capital and less financial capital can be more easily exploited and cheated by those with more; as a result, they are. Repeatedly. Coercion is a feature of the market, not a bug. The reason for this is that (ultimately) markets do not place value on people, they value things / widgets / artefacts of material utility.
However, many of us following in the moral tradition of Kant believe that it is rational to want a society that places value on people rather than on widgets, and to protect that value from a social system which does not share it – which is the entire point of regulating markets.
I’m actually going to put on a libertarian hat for at least a portion of this thread, and point out that, in fact, as a practical matter, despite much striving to convince people to do otherwise, including campaigns at the level of such that in many states, when you obtain your driver’s license, you are asked whether or not you wish to be an organ donor or not, still only a minority of people, whether for reasons of religion, squick factor, simple inertia, or otherwise, volunteer to be organ donors after death, let alone offering up spare parts while living (which obviously involves a far greater sacrifice, though the degree also depends upon which organ; you can spare a kidney more easily than an eye).
Some statistics:
Usual caveat: I don’t take these numbers as gospels, other stats can be found. But they generally agree in principal, if not every last detail.
The most up to date and reliable data comes, I think from UNOS, and particularly here. There are vast shortages and long waiting lists for organs.
So the argument also goes, practically, that for every organ donation that is prevented by banning sale of an organ, a given number of people end up dying for lack of the necessary organ, as well.
So that has to be figured into the moral equation, as well, until such time as we’ve, at the very least, achieved a vastly higher rate of people simply being willing to be voluntary organ donors at death.
Personally, the idea that this doesn’t happen in so many cases simply because of inertia, or lack of caring, offends me tremendously.
This doesn’t mean I want the poor to start seeing large opportunities in selling off limbs and organs, but it does mean, IMO, that there are indeed two sides to the debate over whether allowing monetary transactions in organs from the living should be allowed.
I’d like to think that in the not very distant future, we’ll be able to solve this problem with cloning. (And, no, not via horror movie ideas, a la Michael Bay vehicle, where whole humans are raised only for their parts.)
But we’re not there yet, and won’t be for another couple of decades, or so, I tend to think.
And, naturally, prior to a cloning organs by themselves, option, I also agree we should try to outlaw organlegging, which is to say, enacting a practice of getting most of your parts from criminals sentenced to death, and therefore continously lowering the death penalty to be applicable to ever-more minor crimes.
The problem with unrestricted markets is that they ultimately reward the people who can get away with stealing the eggs.
There is no such thing as an “unrestricted” market. I don’t even know what this means: that everything is for sale?
In fact, all markets have restrictions, which are implied by the very definition of a market that I offered: “a market is an exchange in which a willing buyer and a willing seller mutually agree upon a transaction.” You can’t have a mutual agreement without rules prohibiting a range of sharp dealings.
Publius’ point was that buyers and sellers are often limited by their material circumstances and positions within the market – people with less content knowledge, less know-how, less social capital and less financial capital can be more easily exploited and cheated by those with more; as a result, they are. Repeatedly.
In some circumstances, this can be a problem which can be addressed by the rules governing the market.
“Under a libertarian regime, those requiring a kidney from a donor would be dead before they found the donor because they wouldn’t receive the interim subsidized dialysis from our ‘Socialist’ healthcare system.”
Under our present regime, the current waiting list in the U.S. for a kidney is 85,458 people.
Bluntly, what we are worried about is not a society where nice, happy middle-class people voluntarily choose to sell a kidney to help with college costs for their kids, but a society where extremely poor & desperate people have to sell their kidneys without considering the long-term consequences so they can pay their rent arrears.
In other words, a society headed towards one where very poor people are harvested for their organs by very rich people.
I don’t feel like I need to defend my opposition to that. Gross inequality causes a lot of other problems, some nearly as grotesque, but that doesn’t mean I should accept another one.
Yes, we should reduce inequality, but the way to do that is not to legalize ever more extreme manifestations of that inequality.
Just like forcing a woman through pregnancy and childbirth against her will.
I’ve been thinking about this lately and have come to the conclusion* that forcing a woman through pregnancy and childbirth against her will is a form of torture and, as such, since we don’t torture people to save other people’s lives,** we shouldn’t do so in order to save an unborn fetus.***
*based mostly on observing my wife during her recent pregnancy, which by all accounts was pretty easy on her
**or at least the US used to hold such a view
***obviously there a certain differences between the two situations but I’m not sure they’re material.
It would be interesting to see a bankruptcy judge list a kidney and cornea as assets to be distributed.
I think I would prefer mandatory organ harvesting of the dead before legalizing the sale from the poor.
“It’s a commodification of an essential and irreplaceable aspect of bodily integrity.”
Jes brings up: “For this reason, I also oppose making it legal to hire a woman for surrogate pregnancy: same deal.”
It’s almost as equally interesting a debate. U.S. states vary considerably on where they stand on the issue.
It’s related to the issues in selling organs, but with significant differences, as well. And there are reasonable arguments on both sides, as well, I think.
Ultimately, I think, this is yet another in the endless series of issues that simply ultimately come down to where you wish to draw the line, if you do, on where capitalism should or should not be the reigning modality, and if it shouldn’t be, are you proposing any active alternatives for the gap left, or not?
For instance, if we decided firmly to make illegal all surrogate motherhood payment arrangements, and all selling of organs, I’m guessing most people don’t think laws mandating forced organ donation for criminals, or other classes of people, would be a more moral solution.
Yet while we continue to just try educational campaigns to increase voluntary organ donation from the dead, well as occasional living donations of parts where you can live without your spare, such as one of your kidney, lots of people die on waiting lists.
So it doesn’t remain a simple issue, in my view so far, not being a trained philosopher (oh, if only we knew someone who was expert on bioethics who could help us out here).
“I think I would prefer mandatory organ harvesting of the dead before legalizing the sale from the poor.”
This gets into violating freedom of religion as guaranteed in the First Amendment, to name one obvious problem.
Taking the pro kidney selling argument to the extreme, if a spare kidney is a valuable commodity, should/could its monetary value be considered an asset in a bankruptcy proceeding?
“a market is an exchange in which a willing buyer and a willing seller mutually agree upon a transaction.”
I’d just like to point out that a lot is loaded into the word “willing” here. Suppose A sells B a kidney because otherwise B will shoot him. There’s certainly a sense in which A sold his kidney willingly: he decided that he’d rather be down one kidney and up some money rather than dead. This contrasts to a case where B drugs A, cuts out the kidney while A is unconscious, and leaves some money on the table. A loses his kidney and gains the money, but there’s no decision on his part.
Of course, most people would object that A hasn’t willingly sold his kidney in any *relevant* sense of “willing”–his choice is forced in a way that’s unacceptable.
So consider the case where A sells his kidney, not under fear of being shot, but under fear of starvation. Does he sell the kidney willingly, in the relevant sense of “willing”? How we answer this question, I think, depends on our intuitions about whether or not A’s choice is unacceptably forced–that is, whether or not A is subject to a pernicious form of coercion.
So, von, I don’t think that your definition of a market does as much work as you’d like it to. Instead of arguing over whether or not a particular transaction was coerced, we’ll just argue over whether or not it was entered willingly, in the relevant sense of “willing.”
I am not sure that the First Amendment applies to dead people.
See, I don’t agree at all — I consider myself a liberal (fan of the welfare state, etc.), but I don’t see the idea of markets being by their nature coercive as holding water*; I don’t see the Walmart example as exerting force on the poor**; I’m not particularly bothered by people selling kidneys***.
Same support for suicide and surrogacy, FTR.
*von gets it right at 12:35
**Really, inflation aside, there’s no reason offering somebody $5000 for a finger forces somebody who could use the money to take it; if the offer doesn’t exist, he still needs that money.
***As long as it’s the spare.
What about permitting the sale of organs by the executor of a decedent’s estate to the benefit of the estate & his or her heirs?
von, this is starting to sound very much like a ‘no true Scotsman’ fallacy. All markets have restrictions, yes, but these are restrictions, rules and boundary conditions which have to be imposed externally either by custom or by government. These boundary conditions (for example: salary caps, minimum wage, collective bargaining, environmental laws) are not intrinsic to markets, they are not implied in the definition of a market, and it would be insanity to pretend that they are.
As it stands, I agree with publius that creating a legal space within which sale of organs is permitted would be a moral monstrosity which would victimise people who are poor, who have little content knowledge and little financial, intellectual or social capital.
The comment posted by: Jacob Davies | July 31, 2009 at 12:39 PM settles it for me.
I think that Jesurgislac has the right of it. The coercive power of a market on the poor is a symptom of . . . well, of the circumstances that cause poverty. As a symptom it’s legitimate to look at it when evaluating a narrow policy decision—should we legalize selling kidneys right now, in our current social milieu—but it’s not going to be the foundation for a solid and general moral framework. You’re allowed to say, “I can see an immediate harm this would cause, because right now, many many people are desperate, and this would exploit them,” but I don’t think you’ll be able to follow that back to a principle re: free markets or kidneys, I think you’ll just be able to trace it to some form of due diligence or Hippocratic “don’t screw people over in reality while trying to do good in theory.” On the other hand, I think Jesurgislac’s suggestion that we not commodify elements of bodily integrity probably points towards something reasonably sound. There are other moral issues there, but one big issue is that the model of money, labor, and exchange falls apart when you commodify elements of the people doing the labor, making the exchanges, and holding the money. There’s substantial power in wealth to distort the markets in which it works already, and there’s already very limited freedom to leave a degenerate/broken market and take your labor/wealth elsewhere, but when you start listing economic actors on the exchange it seems like both those problems become unsolvable.
This gets into violating freedom of religion as guaranteed in the First Amendment, to name one obvious problem.
As jrudkis says above, dead bodies don’t have any rights, First Amendment or otherwise, to exercise. And I’d be interested in how the free exercise interpretation would play out in terms of the survivors’ interest in disposing of remains in a certain manner.
von, this is starting to sound very much like a ‘no true Scotsman’ fallacy. All markets have restrictions, yes, but these are restrictions, rules and boundary conditions which have to be imposed externally either by custom or by government.
No, it’s not. It is plausible to argue that defining a market by its rules is somewhat circular, because a market presupposes certain rules defining its boundaries. But my points have nothing to do with the “no true Scotsman” fallacy.
Now, if you’re saying that we can modify the rules the govern markets: indeed we can. (But that’s also not the “no true Scotsman” fallacy.)
I’d just like to point out that a lot is loaded into the word “willing” here.
I’m applying the standard definition, JDKBrown. http://www.google.com/search?q=define%3Awilling&rls=com.microsoft:en-us&ie=UTF-8&oe=UTF-8&startIndex=&startPage=1
Under y’alls thinking, there would be complete market failures at every level for every good. But that doesn’t happen.
“I am not sure that the First Amendment applies to dead people.”
The handling of dead people is, by law, the provision of the heirs; it’s their First Amendment rights that would be at issues, unless someone dies without heirs or will. Similarly, if someone express a desire in a will to be dealth with in a way forbidding organ donation, the law would need to be changed to forbid that, and if the desire was for religious reasons, again the First Amendment would come into play.
“As jrudkis says above, dead bodies don’t have any rights, First Amendment or otherwise, to exercise.”
Phil, that’s just not true: that’s what a legal will is. The law requires the fulfilling of legal provisions of a will. Even after you’re dead.
IANAL, but this is my understanding. Actual lawyers are welcome and encouraged to correct any misunderstanding I might have.
I think that Jesurgislac has the right of it. The coercive power of a market on the poor is a symptom of . . . well, of the circumstances that cause poverty.
Just for clarity: It is not the coercive power of the market on the poor, but the incentives created by poverty itself.
15 people died yesterday for want of a kidney, 15 more will die today.
I take it you didn’t know any of them.
Kidney excision doesn’t lower life expectancy and has negligible side effects. How on earth is *anyone* “victimized” by undergoing a procedure with basically no harmful effects?
Explain that to me. Are we somehow doing violence to the psychic integrity of the seller? Is that worth killing 15 people a day?
Are we scared that poor folks will try to sell both of their kidneys? That the lure of quick kidney-cash will outweigh the prospect of certain death for these poor benighted souls?
I think most of your libertarians could meet you halfway: lets keep it illegal to donate *both* kidneys. Satisfied?
This whole argument is an example of normal thought crippled by the Knobe Effect and too much schlocky science-fiction.
I tend to share the concerns expressed above regarding the sale of kidneys (or other organs that can be removed in relative safety to a live donor.) Given the current shortage of kidneys, my sense is that having a market to sell kidneys would be a pretty good thing; a lot of the concerns regarding oppression can be cured by tightly regulating the market and requiring that the exchange go through a health care provider.
I am a little concerned, however, about the slippery slope. Today, a market for kidneys would probably fill a need. But I am very cautious about creating a world in which the poor exist to provide useful body parts to the rich.
“Just for clarity: It is not the coercive power of the market on the poor, but the incentives created by poverty itself.”
Which is why I believe it’s the moral duty of a rich society to provide a negative income tax, to prevent the existence of poverty beneath a certain minimal level.
Which, as I’ve pointed out many times, makes me as socialist as Milton Friedman.
“Is that worth killing 15 people a day?”
There’s actually a distinction between letting people die for lack of a positive act, and killing people via a positive act.
“…and too much schlocky science-fiction.”
Who ya calling schlocky?
Knobe Effect: this explanation is not a model of clarity as to its conclusions.
And therefore….?
This argues that the issues are “complex” — no disagreement there — and that “consequences… influence… how… action[s]… are judged.”
Which isn’t anything I disagree with, but doesn’t seem to provide much of a helpful answer to any questions.
Perhaps you have a pointer to a better explanation of what you have in mind than simply dropping the name?
Gary,
Those are legislatively created standards: it is not Constitutionally driven. I can see the argument that disposing of a loved ones remains has a religious component, but I am not sure that your wish to dispose of someone else’s body in the way you regard appropriate is unfettered: there are not a lot of people sending bodies down rivers or funeral pyres happening in the US any more, while I suspect some would like to do that (a big bon fire with a keg party when I go might be a good sendoff).
Plus, it might be a good way to help finance healthcare: if you are getting government insurance, the government gets a lien on your organs for when you pass away.
Seems to be an implausible slippery slope, no? The law allows us to sell our gametes to fertility clinics, but I don’t think that any bankruptcy judge has yet been tempted to list eggs/sperm as assets to be distributed.
In fact, the legislative tendency seems to point the other way: perfectly ordinary assets like primary homes are often protected during bankruptcy proceedings. I have few worries that a kidney would become a seizable asset, or that options/futures markets in kidneys would spring up — I’d hope that fairly straightforward regulations could prevent this parade of horribles…
“Kidney excision doesn’t lower life expectancy and has negligible side effects.”
Until or unless you develop a problem with your back-up kidney. Which certainly isn’t unheard of.
Mind, I’m all for voluntary organ donation after death: I’d urge every human being on the planet to sign up for it, and I think people should be free to decide to make voluntary organ donations while living.
von: “But I am very cautious about creating a world in which the poor exist to provide useful body parts to the rich.”
You mean like this?
Radley Balko contributes.
“Seems to be an implausible slippery slope, no? ”
Sure. But without slippery slopes, what would we have to talk about?
Does the law allow any other “irreversible” sales?
-Slavery… no
-Allodial title… not anymore
-Paying someone to be sterilized… maybe?
I really can’t think of any that are definitely allowed.
“I can see the argument that disposing of a loved ones remains has a religious component, but I am not sure that your wish to dispose of someone else’s body in the way you regard appropriate is unfettered: there are not a lot of people sending bodies down rivers or funeral pyres happening in the US any more, while I suspect some would like to do that (a big bon fire with a keg party when I go might be a good sendoff).”
Jewish and Muslim law have mandates on how bodies must be disposed of; both, within Orthodox or strict interpretation, forbid autopsies under most circumstances, for instance. A Jewish take. A Muslim take.
Neither absolutely forbids autopsy, but requires a very good reason.
Summary of one Jewish view:
Naturally, in the U.S., the actual law controls, not religious laws. But religious preferences are relevant, and would become more so the more there would be a movement towards mandatory organ donation even in death.
IANAL, but as I understand it, the law needs a specific reason to violate a will, or religious preference, as to how a body should be treated after death, as in an autopsy or exhumation. IANAL, but I would think organ donation after death falls into the same category.
That’s all I’m saying.
Personally, I’d like to have a loved one with a large freezer they could store me in, both to preserve me for the ever-so-fleeting chance of eventual revival, but mostly so they can remember me every time they get a popsicle or tv dinner, and thus pay their respects.
Failing that, a nice pyramid has been known to last, aside from the looting problem.
And ashes being shot into space has a certain appeal for me.
The latter after all my organs suitable for donation have been removed; I hereby state that if there’s any doubt about it, I want all my organs available for donation after my death, even though I realize this is not a witnessed, legally binding, statement. But I’m making it here in case it’s ever helpful. This has been my lifelong believe, and I have no reason to believe I will ever seriously change this completely serious lifelong preference, which is emphatic.
For the record.
A little research suggests that commonly burial instructions in the U.S. are done in a separate legal instrument than a will, and that every state has its own law on the matter.
Hmmm… it’s true. Basically everything of interest DOES have to do with slippery slopes:
slippery slope
My will currently has my body donated to the army for explosives testing. Presumably it is useful to test real bodies using armor to see if it works.
Exactly, Gary. Maybe we’ve already crossed that bridge, so the appropriate question is whether we deal with it with regulation or leave it to the black market.
Does the law allow any other “irreversible” sales?
Absolutely. Many sales are irreversible (or become irreversible) after a period of time. We also allow sales of goods and services that permanently alter or change the body (e.g., plastic surgery; lasik).
Publius: “I’ve basically said ‘there should be a line,’ but I haven’t established whether kidney selling crosses that line. Maybe someone else can.”
Some of your links make interesting points. One:
Also, specifically addressing the arguments made here, rather than offering a vague I-don’t-know would perhaps be an interesting contribution to the discussion.
“Basically everything of interest DOES have to do with slippery slopes”
Conclusion: everyone should take up recreational skiing as an aid to logical thinking.
Wait, maybe I need more skiing to reconsider the logic there.
Re: Selling children.
Children are not things you own and can therefor sell. They are people you have (temporary) custody of.
While you are living, your body parts are not things you or anyone else owns and can therefor sell. I don’t own my head or my heart. I am a wholeness that consists of my head, heart, various body parts, a spirit (if you believe in that sort of thing), etc.
The very reasonable exception to all this is donation. I think it’s OK to donate a spare kidney to a family member, friend, or total stranger. By my reasoning above, it’s not mine to donate. But I still think I or anyone else should have the right to do it.
It’s odd. I was under the impression that a woman’s right to choose was based on her having control over her own body. If publis believes this, why doesn’t it extend to her kidneys as well?
It’s that I can easily imagine this logic spreading to things like eyes, or even children.
Emphasis mine. Seriously, you make the jump from letting consenting adults do something to selling parts of children? This is right up there with: If we let homosexuals get married then whats next? People marrying toasters?
I believe there was some discussion in the past (in the US), whether the organs of convicts (for life or executed) could be taken by the state after death independent of the will of the convict or his family. Does anybody here know what became of it?
—
Somebody further up the thread hinted at it, could an organ be mortgaged, if a sale was legal?
And then there is that Merchant of Venice precedent 😉
It really comes down to this question – should everything be for sale? You used one’s own body parts? How about children?
Do we have any way to estimate– just for kicks– what a kidney would go for on the open market, if there were such a thing?
My gut leads me in the same direction as Publius, but that’s when I envision someone selling a kidney to make a few rent payments, soon to slide back into debt same as before. It comes out different if the image is “selling a kidney so that you can buy a house in cash”.
“While you are living, your body parts are not things you or anyone else owns and can therefor sell.”
In the U.S., you are legally allowed to sell your blood plasma, your sperm, your eggs, and your hair.
The question of what else of your body you should or should not be allwed to sell is the question under debate.
“By my reasoning above, it’s not mine to donate. But I still think I or anyone else should have the right to do it.”
You seem to be contradicting yourself here.
“It really comes down to this question – should everything be for sale?”
No, it doesn’t. That’s the slippery slope argument: not what “it really comes down to” unless you believe everything ultimately must reach the bottom of all slippery slopes, which is fallacious reasoning.
“I believe there was some discussion in the past (in the US), whether the organs of convicts (for life or executed) could be taken by the state after death independent of the will of the convict or his family”
China does it.
I don’t believe it’s legal in the U.S. at present, but IANAL, and could be wrong. Again, it’s the point of those Larry Niven stories, and making a slippery slope argument there that it would lead to increasing the use of the death penalty.
“Do we have any way to estimate– just for kicks– what a kidney would go for on the open market, if there were such a thing?”
Levy Izhak Rosenbaum :
But that’s on the black market; obviously in an open market prices would drop dramatically. To what extent, who can say?
Indian kidneys would likely go for lower prices than U.S. kidneys until incomes reached greater equivalency, for example.
On a related matter:
What do you think of this idea?
http://www.youtube.com/watch?v=vJkpDNwM0lk
I know that many people are afraid to carry an organ donor card because they fear that people in the hospital could be tempted to accelerate their demise in order to make their organs available. Since there have been convictions on exactly that* these suspicions are at least not totally unfounded.
*and reports of medical personnel pressuring terminally ill patients to give up for the same reason.
But that’s on the black market; obviously in an open market prices would drop dramatically. To what extent, who can say?
I suspect that you’re right, but that the relative price paid to donors would increase. The broker in any black market always takes a substantial cut, which can’t be sustained once the market becomes legal. (See, e.g., booze during and after prohibition.) That’s the irony of the situation: prices fall, but that doesn’t necessarily mean that the monies earned by “producers” falls by as much (or at all … indeed, in this case, it may increase).
I agree that the selling-children argument is silly. I also think the case against kidney sales can be made quite well without it.
The great potential for abuse in the selling of spare kidneys by the living would require what I think would be an onerous anti-abuse regime, making it a choice between the morally repugnant and the impractical. And I would advocate attempts to shut down the black market over supplanting it with a legal one.
“I’m applying the standard definition, JDKBrown….”
This isn’t really responsive, since the standard definition leaves room for argument over cases. The concept of “willing”–along with the concept of “coercion”–is an “open texture” concept: it has vague and shifty boundaries, it comes in degrees, and whether or not it applies in a given instance can be (i) indeterminate and (ii) subject to a sort of conversational negotiation.
You’ll notice, further, that one of the definitions given in your link is something along the lines of “free from coercion.” This, I think, bolsters my case that the argument over coercion that you’re trying to short-circuit is simply going to be recapitulated over willingness.
That said, I’m largely in agreement with you that it’s unhelpful to talk about all markets involving coercion–though I also think it’s equally unhelpful to talk about markets involving willing exchanges–since what’s really at issue is the extent to which participants’ options are *unacceptably* limited. And I also agree that it’s much more useful to frame this discussion in terms of distorting influences on incentives than in terms of the nature of markets themselves.
Really, what the arguments over whether or not market participants are coerced or willing come down to is which influences on incentives we find acceptable.
“Under y’alls thinking, there would be complete market failures at every level for every good. But that doesn’t happen.”
I hope this wasn’t aimed at me, since nothing I said implies anything about market failures.
Adam Smith’s markets are premised upon assumptions that do not, and maybe cannot, exist in the world.\
Market apologists preach from these assumptions, but in the end markets only tend toward efficiency, and are always subject to human manipulation./
Retrospective analysis will show that markets more closely follow Darwin’s, not Smith’s, model./
“What do you think of this idea?”
You broke your link there by putting a spot of HTML tag there. You want to go here.
“What do you think of this idea?”
In answer, I thought I’d already responded on this point about three times already.
“I agree that the selling-children argument is silly.”
On the other hand, we already have what’s close to a selling babies situation in the U.S.
Technically, selling a newborn is illegal. However, making a contract to pay an expectant mother a lot of money to “compensate for her time and trouble,” and you wind up getting first rights to adopt the newborn — though the mother has the right to break the contract, and repay the money, and counter-suits can then be launched or not if she doesn’t repay — is already done a lot. For the record.
I think that the distaste towards selling body parts is not logical, it is visceral and emotional. So I think its hard to come up with an argument supporting a ban on kidney selling for basically the same reasons that its hard to come up with an argument banning prostitution or marijuana or gay marriage, etc.
I mean, poor people are also more likely to sign up to go into the military (i believe, I don’t know for sure) and end up being killed in Iraq, but we tolerate that injustice in the name of our self defense. I think that gettings kidneys to people who need them to survive is an equally compelling justification to tolerate inequal pressure in the market.
I think that allowing people to die due to a lack of access to kidneys, just to satisfy some emotional attachment to the sacredness of body parts, is silly and cruel.
Extreme market situations can show the absurdity of untrammelled “freedom”. How ’bout this one: Selling tickets to a contractually arranged and agreed to (by both and/or more participants) murder?
Also: The claim that markets efficiently allocate resources is simply incorrect.
I’ve actually made arrangements for a medical school to have rights to my body after I’m done with it, assuming that my organs won’t be good for much by that point.
Wondering how Israeli medical schools deal with the conflict between the need for dissection and traditional halachic requirements, I found this article. Basically, the Isaelis have dealt with the conflict by *confronting* it, not (just) in the courts but in the dissection room.
It’s not enough that there are rules — we treat the human body with reverence, but doctors have to have direct physical knowledge of what’s inside — but medical students, rabbis, and teachers have to think about and discuss the rules and what they mean, in every cohort. It’s a very Talmudic style of learning.
Dr. Science, that link is broken; you want to go here.
It’s a useful idea for people to test their links when they preview.
The problem isn’t with von’s understanding of markets, it is that you have expanded the definition of coercion to include pretty much any human interaction which has influences. And if everything is coercive, the word isn’t very useful anymore. I’m very serious about the suggestion that family relations–especially once you look beyond the US and Europe, tend to be much more coercive than markets if we start taking such a broad view of ‘coercion’.
“The problem isn’t with von’s understanding of markets, it is that you have expanded the definition of coercion to include pretty much any human interaction which has influences.”
No, it’s in between those two extremes: I won’t speak for anyone else, but I’d say it’s closer to coercion when there’s an extreme differential of power between the two parties, such that one party is put in the position of suffering significant harm by exercising their option to agree to whatever is put forward. Something like that, anyway.
That’s a lot stronger than any mere “influence,” but not as exclusive as directly putting a gun to someone’s head.
An example would be the options offered to people in company towns. They were free to live, if they thought that somehow they could find another way to survive, but that was a highly dangerous and uncertain option. Similarly, signing yourself into indentured servitude was often “voluntary,” but people often did it because they felt they had little choice.
And so on.
I think there’s a middle ground to not exclude between direct threats of violence, or the equivalent, and “everything is coercive,” that is necessary to acknowledge for discussion of possible human arrangments with each other, and their morality, to be useful.
“They were free to live, if they thought that somehow they could find another way to survive, but that was a highly dangerous and uncertain option.”
Should be: “They were free to live elsewhere, if they thought that somehow they could find another way to survive, but that was a highly dangerous and uncertain option.”
And this is a better example of what can be a bad result of, in the past, “freely choosing” to live in a company town, than the anodyne entry I linked to above.
Sebastian: I’m very serious about the suggestion that family relations–especially once you look beyond the US and Europe, tend to be much more coercive than markets if we start taking such a broad view of ‘coercion’.
Family relationships are necessarily coercive where some family members are completely economically dependent on others. It’s not “US and Europe” – it’s economic coercion even there. Survival, in some instances: if a person has the choice of being supported by their family or dying of poverty, that’s the same lack of choice as we’re discussing with selling kidneys, half a liver, the use of a uterus, etc.
I signed up with the National Bone Marrow Registry when a relative of a friend of a friend needed a donor and my friend organized locally for people to get tested. Even though I’m findamentally cowardly and lazy, I felt that letting someone jab me for testing and thereby potentially later receiving moral pressure to agree to having a really big ugly needle stuck into my thigh bone were a pretty small price to pay for saving the life of a stranger.
So far, about a decade later, if I ever came up as a match the Registry didn’t bother to contact me; I know they still have good contact information, because they check occasionally (and ask for money to pay for the cost of typing people who sign up to the registry, because other wise they have to charge the potential marrow donors).
Thing is, I don’t know whether I’d have signed up for a National Kidney Registry. The procedure is a lot more scary, and the backup kidney does not grow back (unlike the marrow). The costs of donating a kidney are just much greater. And it was a long time ago, but I don’t remember anything about signing up to possibly donate marrow putting me on a registry for possible kidney donors, and I don’t see anything of the sort at the Registry’s FAQ. People are just scared of donating kidneys, and as far as I can tell even the bone marrow donation registry doesn’t want to scare people with the notion that they’ll be contacted with a request that they undergo surgery and lose a kidney to save someone’s life. This should tell you something about the system we have now in the absence of other incentives.
Also, with America’s cockamamie health insurance system, I don’t even know whether it’s safe to donate a kidney, because of the whole “pre-existing condition” issue.
One idea I heard of, in a recent Bloggingheads with Mark Kleiman and Virginia Postrel, was that Israel examined the issue of kidney donation and realized that, in the context of a national healthcare system, the state saves a lot of money compared to dialysis, and it makes sense to give some of that money to the donor to defray their hassle. That notion, were an individual wealthy recipient gains no advantage, appeals to me – so long as donors must also be full citizens eligible for state-funded medical care, rather than migrants transiently appearing to sell their kidney.
Gary, ” won’t speak for anyone else, but I’d say it’s closer to coercion when there’s an extreme differential of power between the two parties, such that one party is put in the position of suffering significant harm by exercising their option to agree to whatever is put forward.”
Yes, but I’m arguing against the contention (as raised in this thread) that “Occurs to me that all markets are coersive by their very definition“.
I’m not arguing that it is impossible for any market anywhere to be coercive. I’m arguing against the idea that markets are by nature coercive. They aren’t. They are much less coercive “by nature” than most human institutions. Can they be used in a coercive fashion? Sure. But are they definitionally coercive? No. And they are less definitionally coercive than governments, families, and most religious structures.
Jes, “Family relationships are necessarily coercive where some family members are completely economically dependent on others. It’s not “US and Europe” – it’s economic coercion even there.”
I agree completely. But I don’t agree if you are saying that they are only coercive when economic dependence is at stake. If we are opening it up to a level where all economic market transactions are coercive by their very definition, most family interactions are coercive at least that much if not more so.
“Survival, in some instances: if a person has the choice of being supported by their family or dying of poverty, that’s the same lack of choice as we’re discussing with selling kidneys, half a liver, the use of a uterus, etc.”
Well for at least selling kidneys in the US or UK, there are very few people (if any) where the literal choice would be between selling a kidney and DYING of poverty.
Laws against selling organs largely come out of the same spirit that adoptions are highly regulated. No ethical system can capture the totality of the market, and most laws liberalizing kidney sales will see it being used to expand aquisition techniques or launder illegal adoption through a part of the system.
Global grain markets have killed over 100million people over the last couple of centuries via the famines caused. The immorality of a similar and more intimate dynamic is a bit more immediate and gruesome than we’re willing to buy grain at a price higher than starving people can pay.
What societal or individual good are we talking about here?
Is the issue making organs available for those who need them, or creating a market for organs that anyone can participate in?
I have a visceral response to the latter possibility, predicated exactly on the potential for coercive interactions. Not only the potential coercive interactions already mentioned here, but an added one: advertising.
Imagine what happens to the poor and the working poor once organ-procurement companies start advertising. “Pay off your debt!” “Put your children through school!” Advertising would normalize the concept of selling off one’s body parts, until people who don’t want any part of the idea would be considered the weird ones (just as people who don’t want cell phones/Blackberrys because they don’t *want* to be available to everyone all the time are considered weird).
We do have a history of seeing what happens when previously non-commodified things become commodified, and it is never a positive thing. Ever.
Here’s another issue: The organ-selling moral dilemma would become moot if we could grow our own replacement organs from our own stem cells. Growing our own replacement organs from our own stem cells also obviates a lot of ancillary problems, such as rejection issues, and the need to avoid rejection by, essentially, gutting one’s own immune system.
I don’t know if growing our own replacement parts from our own stem cells is possible, but I do know that refusing to allow or fund stem cell research will keep us from ever finding out if it is possible.
It would be a moral travesty, an absolute moral travesty, for us to allow an open market in organ selling while oh-so-fastidiously refusing to even try to develop a technology for growing cloned organs.
“I’m not arguing that it is impossible for any market anywhere to be coercive. I’m arguing against the idea that markets are by nature coercive. They aren’t. They are much less coercive ‘by nature’ than most human institutions. Can they be used in a coercive fashion? Sure. But are they definitionally coercive? No. And they are less definitionally coercive than governments, families, and most religious structures.”
Okay, I don’t disagree with any of that.
“Is the issue making organs available for those who need them, or creating a market for organs that anyone can participate in?”
Much more the former than the latter, in my thinking, anyway.
“Here’s another issue: The organ-selling moral dilemma would become moot if we could grow our own replacement organs from our own stem cells.”
I was going to point out that I brought this up long ago in this thread, but that post no longer appears to be there. Apparently it was eaten by Typepad while I wasn’t looking. Sigh.
Anyway, my basic point is that technoqlogy in another twenty years or so, maybe a bit sooner, maybe a bit later, will make this an obsolete question.
I seem to recall addressing other issues in the same comment.
“If only we had a real philosopher who blogged here…”
Hilzoy, we miss you!!!
Sebastian: Well for at least selling kidneys in the US or UK, there are very few people (if any) where the literal choice would be between selling a kidney and DYING of poverty.
At least 18 000 people a year die of poverty in the US – I mean the uninsured, of course: poverty is peculiarly lethal in a country where access to health is rationed by money. More, probably, if we count those who die of hunger, though I suspect that American households where people go without enough food are more likely also to be households whether they do without health insurance.
You think, if it was legal for a parent to sell a kidney, that some children wouldn’t end up growing up with only one kidney? You think, even if a person was only allowed to sell their own kidney, that some people wouldn’t end up selling a kidney because it was that or death – if not for them, for someone they cared for enough to run the risk of living with just one kidney?
Though you evidently prefer to dismiss sight unseen the people who die of poverty in the US, they still exist: they die below your field of vision, Sebastian, but they still die. They’ll die a little faster if they’re allowed to sell a kidney or half a liver: and you will still never notice them. Too poor for you to see them.
Jes, could you please try to have an argument in which you do not denounce the inhumanity of your interlocutor?
Do you think Sebastian wasn’t appearing intentionally inhuman? That for all his vaunted interest in healthcare, he really didn’t know that people die for lack of it?
That is an odd use of the word, force. The willingness of a seller to pay a specified price is quite a different thing from the application of physical power, strength or compulsion. Even in the context of opportunity cost, a missed opportunity hardly constitutes “force”.
Some commenters have suggested that a pregnant woman can be “forced” to carry the pregnancy to term. I suppose that that is hypothetically possible, in the sense of a husband, partner or parent telling the woman that if she aborts, he will kill or maim her in retaliation.
The more common use of the phrase “forced pregnancy”, however, is to suggest that criminalizing abortion will result in forcing pregnant women to carry to term. To the contrary, the unimpeded development of the embryo/fetus to term occurs naturally as a result of the absence of force.
The poor on the organ transplant lists are going to die a lot faster if they don’t get the organs they need.
John: The more common use of the phrase “forced pregnancy”, however, is to suggest that criminalizing abortion will result in forcing pregnant women to carry to term.
In point of fact, criminalizing abortion merely results – statistically – in about the same number of abortions taking place, legally or illegally, plus an increased maternal mortality and morbidity rate, reflecting the legal requirement on doctors to refrain from advising women that continued pregnancy will threaten their health or their life, plus the increased incidence of unsafe illagel abortions.
It would therefore probably be more accurate to refer to the people who advocate criminalizing abortion as people who attempt forced pregnancy, since that’s the goal they claim: and even if, as a general trend they never achieve it, in particular cases, making abortion illegal probably does result in some success for the forced pregnancy movement.
To the contrary, the unimpeded development of the embryo/fetus to term occurs naturally as a result of the absence of force.
No: it occurs naturally – presuming no miscarriage – if a woman decides not to terminate. Unimpeded development of an embryo/fetus does not occur in a random vaccum of golden light: a woman is required, and unless you believe in slavery, that woman must get to decide for herself if that’s what she wants to do.
The phrases, “forced pregnancy” and “forced pregnancy movement” never cease to puzzle me. For what it’s worth, I support abortion rights prior to fetal viability. A pregnant woman, and no one else, should be the one to decide whether she carries her not-yet-viable fetus to term. I also support using language accurately.
With the exception of a rapist, I know of no one who favors “forcing pregnancy” upon any woman. Pregnancy, however, does sometimes occur from unforced sex. That natural process is not a forced pregnancy; it is a pregnancy. The zygote/embryo/fetus develops to term (inside the woman, for the pedantic among us) in the absence of a naturally occurring miscarriage or spontaneous abortion. Should the mother choose a surgical abortion, that procedure forcibly terminates the pregnancy.
For some reason which I don’t understand, many abortion rights advocates seem squeamish about calling the procedure by its name. Let’s leave both the euphemisms and the pejoratives to the Orwellians on the other side of the debate. Abortion is what it is, and it should not be the fundamental constitutional right that dare not speak its name.
John, don’t be euphemistic. If a woman has made the decision to terminate her pregnancy, and some outside force prevents her, from that point on it’s a forced pregnancy.
Your notion that it’s OK to force a woman to die or be permanently damaged/disabled because the fetus she is carrying could, in theory, survive if she terminated her pregnancy by live delivery, is just… well: dismissive of women as human beings. Women retain the right to care for their own bodies even when they are carrying a fetus older than 24 weeks. Doctor George Tiller was murdered by people who agreed with you that women ought not to be allowed to make decisions like that in the third trimester…
For reasons which I understand perfectlt, many forced pregnancy advocates are squeamish about calling what they advocate for by its name: they’re against safe legal abortion, and therefore for forced pregnancy.
John in Nashville: “To the contrary, the unimpeded development of the embryo/fetus to term occurs naturally as a result of the absence of force.”
Like in rape? Oh, wait. You figured that one out. How about forced marriages? Arranged marriages? Restrictions on birth control? Polygamy? Restrictions on sex education? Basically, anti-aborters of all stripes desire to use the state’s monopoly of force to achieve a desired social end–pregnancy to term.
Hence the term.
“Do you think Sebastian wasn’t appearing intentionally inhuman? That for all his vaunted interest in healthcare, he really didn’t know that people die for lack of it.”
Fascinating that you take this tact when you are advocating a position that by your logic means that you DESIRE that those who can’t get kidneys will die by the thousands. Why do you hate people with kidney disease, Jes?
Jesurgislac, I did not express an opinion about post-viability abortions. I am accordingly puzzled by the non sequitur whereby you attribute such views to me as you surmise.
Had you asked, I would have acknowledged that there are extraordinary circumstances under which I would support–on a choice among bad alternative outcomes theory–the right of a pregnant woman to abort a viable fetus. I recognize, however, that it is easer to posit a straw man than to ask.
Easier, but nonetheless pathetic.
I read a very interesting book in college 30+ years ago called “The Gift Relationship.” (Sorry, don’t remember the author.) It was about the purchasing of blood by blood banks, which was a common practice back then. Predictably, most of the sellers were poor people, often hardcore alcoholics looking for quick money for a bottle. The book was an eloquent argument against the practice, which was curtailed, thankfully before the AIDS epidemic (easy to imagine the havoc that could have happened there). I think the same arguments apply even more strongly to selling organs.
While we are at donating bodies to science 😉
http://www.youtube.com/watch?v=pnvZpi3nbsc
medical love song.
Romania under Ceaucescu came close to ‘forced pregnancy’ policies iirc. And a lot of (usually right-wing) thinkers especially in the late 19th and early 20th century proposed such schemes (usually in combination with abortion/sterilization programs for the ‘undesired’). The Nazis did not invent the concept and actually did not even come near the more radical ones.
We should probably be happy that organ transplants were not yet really feasible at the time or the Holocaust could have turned into operation harvest (although there were racial theoreticians, Hitler among them, that thought that ‘Jewishness’ could be transmitted via body fluids and tissue like an infectious disease).
This reminds me of one of the reasons I remain against full legalization of prostitution: if it became legalized and more or less accepted, then sooner or later, conservatives would tell poor women that they shouldn’t expect government handouts when they can always garner additional income by renting out their bodies.
I’m surprised that there aren’t more references to Larry Niven’s “Organlegger” stories. To my mind, the real danger in allowing a market in donated organs to exist is the problems inherent in making sure that the organs weren’t stolen in one way or another.
In the “Organlegger” story cycle, organ transplants were fairly routine – but the demand for organs was much higher than the supply of willing donors. Thus, capital punishment was carried out by harvesting useable organs from the condemned. This lead to many abuses, where jaywalking was a capital crime – and muggers didn’t just steal your wallet.
Sure, it was just fiction – but once there’s a market for buying and selling organs, there will be abuse of that market. There are a large number of “grey markets” today where inferior (cheaper) products are passed off as more expensive products (cheap ethylene glycol passed off as glycerine comes to mind – remember the resulting deaths?) What happens when paramilitary dictatorships can make boatloads of money by selling the organs of political opponents in the world marketplace? How about when chimpanzee kidneys are swapped out for human kidneys?
The only way to ensure that the organs were voluntarily donated is to outlaw the buying and selling of organs. No profit motive means the threat of abuse remains small.
“I’m surprised that there aren’t more references to Larry Niven’s
‘Organlegger’ stories.”
I mentioned them twice, and got a dismissive response of a reference to “schlocky sf.”
O.K., let me indulge the full liberertarian program for a free society as a way of adding clarity to the organ-donation debate.
If we permit potential-kidney donors (all of us) to carry concealed weapons for self-defense, it will minimize the theft of one’s kidneys by those who walk around demanding our kidneys without payment and before we even think about donating them.
I’d be willing to subsidize weapons for the poor, who might be at a disadvantage in the kidney marketplace because the rich can afford cool weapons and just, you know, demand that a less well-off guy hand over a kidney or two.
Now, if it came to actual gunplay, which it will in a fully libertarian vision of how things would work (and what would freedom be without a shoot-em-up now and again), you take care not to shoot the rich guy in the kidney, or any of the other major useful organs, but you damned well kill him (in self-defense) if you have to and then … and only then ….. do you harvest his organs for those who need them, rich and poor alike.
What you’ve got here is guns, freedom and kidneys. Add in a little Latin legalese, and I think we’ve found our way clear.
those who can’t get kidneys will die by the thousands
Oh my gosh. Did Sebastian really just make a “to each according to his needs” argument?
If I will die without a kidney may I force you to give me one of yours? If not, why do you hate people with kidney disease?
An article on the reality of organ sellers in Pakistan (free reg required), some excerpts below and discussion in the comments here.
Mythago, you might want to look at the context. I’m using Jesurgislac’s bad argument and showing that it is bad. Right?
Sebastian: Fascinating that you take this tact when you are advocating a position that by your logic means that you DESIRE that those who can’t get kidneys will die by the thousands.
You can get kidneys in any good butcher’s shop… oh wait. You mean, human kidneys.
Yeah: fascinating that I’m taking the position that the use of human organs to save other people’s lives should not be coerced. Or, you know, predictable.
The odd thing about the forced-pregnancy movement for me has been that so many advocates of forced pregnancy have apparently decided that the uterus is the one human organ which it’s perfectly OK for the state to enforce the use of to save another person’s life: an enforcement which they would for the most part reject for other human organs. It seems unsurprising to me that people who are in favor of the forced use of uteruses, would also favor the forced use of other organs – providing they’re confident that they’re never going to be the ones so forced.
But, that’s a bit of a distraction. Were you in fact consciously inhumanly deciding that the 18 000 people who die of poverty each year in the US were not even worth acknowledging, or were you simply ignorant that depriving people of access to health care kills?
“Yeah: fascinating that I’m taking the position that the use of human organs to save other people’s lives should not be coerced.”
Me too. Which is not at all the same position as that they shouldn’t ever be sold. Which is ummm, what we are talking about. (We’ve also established that markets are generally less coercive than many/most other human interactions, so your critique using ‘coerced’ proves far too much).
Uhhh…there’s folks out there that want to regulate uteruses? There’s been legislation proposed that might do this? Cite?
Sebastian: Me too. Which is not at all the same position as that they shouldn’t ever be sold.
Ah: so it’s OK to coerce poor people? The kind of people you don’t even believe exist?
Slarti: Uhhh…there’s folks out there that want to regulate uteruses? There’s been legislation proposed that might do this?
You may or may not be aware of this, Slarti, if your sex education stopped with the birds and the bees, but in human beings, a fetus can only be gestated to term in a human uterus.
So, if you were unaware of this aspect of human development till now, you may now be better informed: yes, all that messy talk about abortion laws was in fact all about state regulation of women’s uteruses.
That’s some creative reasoning, right there.
I’ve just cruised through the relevant legislation, and the word uterus seems to be absent. Also, the prohibition is on doctors performing the procedure.
So what’s being regulated is doctors, no?
That’s some creative reasoning, right there.
No, Slarti, I assure you, it’s really true. If you don’t believe me about pregnancy, abortions, and uteruses, I suggest you consult a medical adviser you trust. They may be a little surprised that you got to your present age without knowing that the uterus is where a fetus must develop, but really; you deserve to be better educated than this.
So what’s being regulated is doctors, no?
No, Slarti. Fetuses don’t arrive in the doctor’s black bag, either, no matter what your mom told you.
Nor do kidneys. See, doctors do more than one kind of thing. Didn’t your mom tell you?
Nor do kidneys.
Ah, now that’s vintage crypto-Slarti. Possibly an attempt to bring this conversation back on topic? *muses* Could be!
Yes, somewhat. Also, since you’ve elected to make as if you’re conversing with an idiot, I don’t see the point in using the long form.
The “forced gestation” paradigm just won’t wash, nor will the absurd notion that abortion legislation has anything, other than incidentally, to do with regulating women’s uteruses.
Does anyone else want to use uteri, or does that, as Hannibal Lecter said, ‘smell of the lamp’?
It really comes down to this question – should everything be for sale? You used one’s own body parts? How about children?
Hasn’t Richard Posner already gone there?
Slarti: Also, since you’ve elected to make as if you’re conversing with an idiot
Why, yes. But then, you started it by electing to make as if you were really as absolutely ignorant of human biology as, well… an innocent?
Liberal Japonicus: Does anyone else want to use uteri
I considered it, and decided that the temptation to use Latin plurals for English words is a false temptation and to be avoided: like octopi instead of octopuses.
Great post. Ultimately I disagree, but it has helped clarify my thinking.
Your description of modern libertarianism is wrong. Sophisticated libertarians now recognize that inequality does indeed limit freedom. But they also believe that however bad the free market may be at allocating scarce resources, in most cases political allocation is even worse.
The current political allocation of organs is less egalitarian than a more free market allocation would likely be. Today people of modest and normal means die waiting for organ transplants, but those with connections and great wealth can get transplants. See e.g. Marion Barry and Steve Jobs.
I understand biology well enough. You’re just coming to conclusions that don’t follow at all from anything I said.
Typical, really.
What is a false temptation? A temptation that isn’t really tempting?
Slartibartfast: You’re just coming to conclusions that don’t follow at all from anything I said.
Ah. So you were being cryptic again. Hokay.
Liberal Japonicus: What is a false temptation? A temptation that isn’t really tempting?
When a temptation sits down beside you and smiles into your eyes and says “why not use octopi, it’ll make you look smart” and then while you’re smiling back, all eyes (and 8 arms) the temptation picks your pocket and stabs you in the back and runs away, that’s a false temptation.
Uteri makes you look smart? I don’t know about you, but when I write, I hear the words in my head, and when I get to “uteruses”, I hear the sounds of screeching brakes. YMMV of course.
But my wonder is how can a temptation be false or true? I thinking that a temptation by default leads you to do something that you shouldn’t do, so ‘false’ actually contradicts the meaning of temptation. I’m not sure that anthropomorphizing the word temptation helps, unless it’s just a chance to make a snide comment.
There is something almost autistic about Libertarians who approach this solely as a matter of consent, without any empathic appreciation for the desperation that would drive a person to sell a kidney. They would ask us to treat “consent” driven by extreme desperation as if it is ethically comparable to a billionaire’s “consent” to purchase a Ferrari.
As a former Libertarian looking back at the point of view I held in my youth, I can see why Libertarianism is disproportionately a young, white, upper middle class, male phenomenon. People whose experiential baseline is one of privilege and people who haven’t lived long enough to experience unremitting pain and suffering (i.e, privileged adolescents) have a seriously attenuated understanding of matters like choice and consent.
What’s the big deal?
Wouldn’t a rich man have just as much right to sell one or both of his kidneys as a poor man?
And just as much right to sleep under bridges or steal bread, too.
WRT uteri and octopi and to lighten the tone a bit:
Behold the hippopotamus!
We laugh at how he looks to us,
And yet in moments dank and grim,
I wonder how we look to him.
Peace, peace, thou hippopotamus!
We really look all right to us,
As you no doubt delight the eye
Of other hippopotami.
-Ogden Nash
This reminds me of one of the reasons I remain against full legalization of prostitution: if it became legalized and more or less accepted, then sooner or later, conservatives would tell poor women that they shouldn’t expect government handouts when they can always garner additional income by renting out their bodies.
Ironically that became (in theory) a problem in Germany recently. At about the same time that prostitution was legalized the unemployment benefit regulations were changed. The state can cut the benefits when an unemployed person refuses an “acceptable” job offer. This was updated to make any legal job acceptable by definition (i.e. one could not refuse a job simply because it was below one’s qualification).
Since that meant in theory that the unemployment office could offer jobs as whores to any unemployed woman and cut benefits, if that offer was refused, there was an official dispute in parliament about that. I think the result was that brothels that could go to the unmeployment office (i.e. legal ones) would not be interested in involuntary sex workers in the first place, so the case would not actually occur and that it would not be used to save money by making offers that would be almost automatically refused.
Lordy, the old repugnant transactions argument again.
“You” should not be able to sell your kidney because according to “my” moral code it is repugnant for you to do so.
No, not a liberal argument (in Mill’s or Smith’s sense).
A liberal argument would be “you may not sell your kidney because it damages either the person or rights of a third person”.
Which, err, it doesn’t. Rather, it enhances the possibility of another person to enjoy their rights by actually living to exercise them.
One very much more important thing needs to be noted. There is a country with a paid makret for live kidney transplants. Iran.
Regulated, yes, the govt provides around a year’s average income to the donor as payment and that can be topped up by the recipient. All medical bills are paid, of course.
There is also, and there’s some suspicion that this might not be entirely random coincidence, one country in the world that does not have a shortage of kidneys for transplant. Yes, Iran.
Me? I thought it was part of the liberal (in the modern, US sense) creed that we should look around the world and see what other people do better than we do. Apparently not though, not when the repugnance factor kicks in.
Which really boils down to, “Ooooh, no, you can’t pay money for that, that’s icky!”.
Hopefully the adults will be along in a few decades…..
Tim,
Although one might try to make the “selling kidneys is icky” argument, it’s not the only argument against organ markets; nor is it the one a lot of people here seem to be making. Which is good because, as you say, it’s a pretty poor argument.
If you’re interested in a stronger argument, have a look at Debra Satz’s “The Moral Limits of Markets–The Case of Kidneys,” which you can find through
http://philpapers.org/autosense.pl?searchStr=Debra%20Satz
It’s behind a paywall, so if you can’t access it, try “Noxious Markets: Why Should Some Things not be for Sale?” instead; an early draft is at
http://www3.law.nyu.edu/clppt/program2002/readings/satz/satz.pdf
Which really boils down to, “Ooooh, no, you can’t pay money for that, that’s icky!”.
Hopefully the adults will be along in a few decades…..
So mischaracterizing arguments you disagree with in order to call your interlocutors childish is a sign of maturity these days?
Look, just… no. This is not about squeamishness. Okay, yes, I’m sure it is in some cases, but that’s far from the only possible reason to oppose it. My own opposition boils down to “Ooooh, no, you can’t pay money for that, that’s exploitative!”. I’m keenly aware that the libertarian argument boils down to “Nuh uh! It’s the market, so it totally can’t be!”, or less succinctly, that the market, in its majestic equality, would allow the rich as well as the poor to hock a kidney to pay the bills. Uh-huh. Right.
Look. It’s not a question of squeamishness. It’s a question of setting up a situation whereby a limited segment of society is encouraged to gamble with their health. If the paid donor later encounters a condition that would have led to single kidney failure in a person with two healthy kidneys, said donor is now another number on the recipient waiting list, and/or taking whatever was left of their payout to cover their medical bills and buy someone else’s kidney.
One point on which I could be swayed would be some convincing figures showing that single kidney failure is relatively rare compared to double kidney failure. My modest poking about online turned up no information in that regard, however. But if it could be shown that someone with a single kidney is not substantially more vulnerable to end up on the other side of a kidney purchase, I’d be far less inclined to viscerally oppose it.
Tim W: A liberal argument would be “you may not sell your kidney because it damages either the person or rights of a third person”.
Which, err, it doesn’t.
Another way of putting that argument would be: “You are not allowed to buy a kidney, because if you do so, you are using your wealth to damage another person”.
People who need an organ transplant have to hope to have what they need given to them: no matter how wealthy they are, they cannot legally use their wealth to purchase another person’s living body, in whole or in part. To people who are accustomed to health care being rationed by wealth alone – the poorer you are, the less you get: the wealthier you are, the more you get – this curious gap in health care, where no matter how rich you are you cannot simply buy what you need – must ache like a sore tooth. It is a curious anomaly in the otherwise broken US system: a place where money doesn’t apply (except in the basic US dead-of-poverty sense, as someone without health insurance is unlikely to survive very long waiting on the transplant list).
One very much more important thing needs to be noted. There is a country with a paid makret for live kidney transplants. Iran.
Regulated, yes, the govt provides around a year’s average income to the donor as payment and that can be topped up by the recipient. All medical bills are paid, of course.
It would be interesting to know more about how this actually works – how the people who sell their kidneys feel about the sale years afterward: whether the recipients bid on donor kidneys – if the person selling the kidney is able to regulate such an auction: etc.
No, you were just drawing unjustified conclusions that conveniently demonize someone else’s point of view, again. Or, more accurately: still. Either you’re being deliberately dishonest in completely making up things and assigning them to me, or you’ve got some serious head-logic haywire going on.
Oh, goody. It’s catching.
No, you were just drawing unjustified conclusions that conveniently demonize someone else’s point of view, again.
Now you’re just chock-full of self-pity because the rhetorical trick of pretending that you didn’t understand that abortion law has directly to do with regulating uteruses, kind of backfired on you. Shame. Take your rhetorical defeat with a bit less self-pity and a bit more resolution, will you?
I’m begining to think that this is J being uncontrollably self-delusional. Some people you can discuss things with, because they’re not too busy hearing voices to pay attention. This is obviously not one of those people.
I’m not sure if anyone has cleared this up yet, but for what it’s worth I’ve got both “The Jigsaw Man” and The Long ARM of Gil Hamilton. In Larry Niven’s organlegger stories the organ supplies are communal, there are public organ banks, etc., supplied from accidental deaths and (to a great extent) from executed criminals. I see no signs that the sale of organs is legal in these stories. Buying organs, from the organleggers, because you want a young organ or not to have to wait for one or etc., is illegal.
It’s a small point, but Niven’s stories have been frequently raised in this thread, so: Niven’s stories do not deal with a legal market in organs, or how one could be bad or go awry. They can legitimately be raised as illustrations of how – under maximally-successful transplant-tech regimes, where people could actually live arbitrarily long with a steady supply of needed replacements – getting organs from executed criminals could make for nasty social incentives if the public is really worried about the banks being empty.
I’m begining to think that this is J being uncontrollably self-delusional. Some people you can discuss things with, because they’re not too busy hearing voices to pay attention. This is obviously not one of those people.
I’m beginning to think this is Slartibartfast descending rather rapidly to ad hom.
(Also with the illegal organlegging, no one was selling their own organs. The organleggers kidnapped people, murdered them, and broke them up for the parts. Like I say, the comparability is limited.)
End illustration quibbling. Gary had it right, but I thought RepubAnon was further afield with his “abuse of the market” argument.
Niven schlocky? What counts as schlocky?
However, this strange business a few years back would be along the lines of RepubAnon’s point:
http://en.wikipedia.org/wiki/Reports_of_organ_harvesting_from_Falun_Gong_practitioners_in_China
“The organleggers kidnapped people, murdered them, and broke them up for the parts.”
In A Gift From Earth, organs were obtained by having the death penalty result in one’s organs going to the organ banks. Eventually, relatively minor offenses merited the death penalty to keep the organ banks adequately supplied. All perfectly legal, only the law was set by potential organ recipients, and not potential “donors”.
And then, eventually, some bad things happened, and things changed.
I do not buy the slippery slope argument. After all, we did away with indentured servitude some time ago. We are not going to bring it back.
And yes, selling organs is vulnerable to exploitation. But how about a middle way? Allow people to sell their organs, but only if they are harvested after death? The organs would have to be healthy when sold, and the risk that they would be unhealthy at death means that they would be relatively cheap. But not enough people donate their organs as it is. A futures market in organs would benefit future recipients. And if poor people got $100,000 for selling their healthy organs in this way, would that be so bad? There could also be installment plans, where the seller would get so much per year as long as their organs remained healthy. That might provide both the incentive and the means for poor people to maintain their health. 🙂
And if poor people got $100,000 for selling their healthy organs in this way, would that be so bad?
Contra the song, suicide is not painless.
“I’m beginning to think this is Slartibartfast descending rather rapidly to ad hom.”
It seems more a comment on your style of thinking, as you present in your writing. You seem to consistently be unable to conceive that another person could look at the same set of facts and interpret them differently than you, or fit them into a different pattern of conclusions than you, and when they do, and say they do, you accuse them of “pretending” or of deliberate deception.
I think you do this honestly, in that you seem literally unable to understand that there are other legitimate — however “right” or “wrong — ways of viewing a set of facts that don’t inevitably lead to the conclusions you come to. As a result, you constantly impute bad faith to people when there merely is a difference of interpretation and of opinion.
I don’t mean this as an attack on your person; I do wish you were able to look at other people’s views differently, more generously, and with more of an open mind, rather than insisting you have The One Correct Interpretation, and anyone who takes a different view is dishonest or pretending to not see The One Correct View. It’s a pattern you repeat over and over again with a wide variety of quite different individuals.
But you always view it as their fault. You could, instead, try to understand how they might have a different view, and what that might be, and grant that they might take that view — however “wrong” it might be — in good faith. And then proceed from that premise, rather than constantly accusing other people of writing in bad faith.
This at July 31, 2009 at 12:31 PM is my comment that was previously eaten by Typepad, due to my not having noticed I had five links in it, past the four-link limit, in case anyone was wondering what I was referring to when I was first puzzled why no one responded to my first introduction of “organ-legging,” Niven, and various other stuff in that comment.
“I think you do this honestly, in that you seem literally unable to understand that there are other legitimate — however “right” or “wrong — ways of viewing a set of facts that don’t inevitably lead to the conclusions you come to.”
I think that the problem is actually deeper than that, and was what I was getting at when I asked what a “false” temptation was, which seems to mirror her notion that there is one ‘true’ stance on a particular set of facts and every other one is ‘false’. Now, it might have just been an opportunity to throw a snide remark my way, though it was one that only works if you realize that she was being snide (She accused me of wanting to ‘look smart’, which works out as a shot only if I get the point that she thinks I’m not smart and the desire for the appearance of intelligence is also a claim of how the truth underlying is at odds with the appearance)
Jes has admitted error on a few occasions (the last time I think was when she referenced a different argument that had taken place in a different forum) so she is not incapable of doing so. But the reflex to define things as A/not-A seems to be overwhelming and to back away from that would not simply be a one off error, but an acknowledgement with a fundamental problem of world view. I would guess that the justification is that somehow, the topics that Jes has this reflex on are ones that she feels she has special insight into, such as LGBT issues or feminism or the treatment of minorities, but her feelings of expertise then seem to morph into claims of expertise on race and diet and a range of other topics. Unfortunately, the only person who she might consider taking this criticism from around here was Hilzoy (and even then, I’m not sure), so I don’t hold out much hope for change.
On the flip side, when Slarti writes “The ‘forced gestation’ paradigm just won’t wash, nor will the absurd notion that abortion legislation has anything, other than incidentally, to do with regulating women’s uteruses.” I think he’s being unnecessarily dismissive by taking Jes’ comment as a literal one, rather than what’s, in fact, a quite common metaphor in feminist terms, and one that has an entirely defensible social theory behind it.
That is, “regulating women’s uteruses” is a way of referring to the history of men’s general use of power to generally control the lives of women both individually and socially, and that, in short, is what the basis of feminist theory is, and I suspect Slartibartast is — I could be entirely wrong — not highly well read on feminist theory, and familiar with the terminology or assumptions.
And as a general statement, I think that most everyone — particularly most men, but not just limited to men — can benefit from more reading of various feminist writers, even if one has specific disagreements with specific claims, specific subtheories, or specific writers. I think it particularly behooves men to listen to women when they talk about their experiences, and the general theories of feminism, no matter how irritating any given individuals might be as to how they go about it.
This is all personal opinion, of course, and can be dismissed, ignored, or done whatever the reader thinks is appropriate with it.
May I buy a human kidney because I enjoy a human kidney pie occasionally?
Why not?
“May I buy a human kidney because I enjoy a human kidney pie occasionally?”
Does this mean you can’t oppose the buying of human blood plasma as a beverage, but support the compensation of paying people for donating human blood plasma?
We can make distinctions as to what’s permissible to do with something depending on the reason and thing we want to do to that something.
For instance, we can say it’s permissible to do a certain thing to save a life, but not permissible to do it to enjoy a snack.
Thus we refute Hannibal Lecter.
Also, as was previously pointed out, permitting the selling of something by an individual doesn’t at all imply permitting the buying by an individual of the same thing. Things can be sold to the government for distribution, or to a private medical foundation, or any number of charitable institutions, for distribution in what’s considered the most fair way, and selling to individuals purely on the basis of who is willing to pay the most money forbidden.
In other words, funny remark, John, but not a serious argument.
You’re not entirely wrong, Gary. I do think that it’s valuable to occasionally make contact with what’s so, even if what seems to be makes for better & more useful rhetoric.
The thing is, Jesurgislac and I aren’t all that much at odds with each other as far as abortion law is concerned. I just take exception to some of the rhetoric she uses.
And now? I’m pretty much done with her. This latest bit of nastiness has convinced me that there’s nothing over there behind her eyeballs that’s worth my time. And the peculiar thing is, I’m the one who resorted to ad hominem. Me, the one who received inadequate education in human sex and reproduction from his mommy; the one who thought that babies are brought in the doctor’s bag. Once upon a time this would have amused me, but there’s no humor in this kind of thing anymore for me.
Hopefully that’s a good thing.
“Sebastian: Me too. Which is not at all the same position as that they shouldn’t ever be sold.
Ah: so it’s OK to coerce poor people? The kind of people you don’t even believe exist?”
The last clause is mysterious but I’ll ignore it because you can’t possibly believe that.
As for the rest, in order to get there you need to establish one or more of the following:
A) that market transactions are always coercive, and more so than most other human exchanges;
B) That the sale of kidneys is especially subject to abuse, more so than say the sale of labor;
and/or
C) That the sale of kidneys has especially bad effects and thus shouldn’t be treated like other transactions.
You argue as if you have established ‘A’, when you in fact have done no such thing.
You haven’t really tried to argue ‘B’, you have just asserted it.
C appears to be false. People who have donated a kidney don’t appear to have an increased risk for kidney failure and don’t appear to have an increased mortality rate when they contract a kidney disease.
It’s SciFi. (For some that’s all it takes)
What bothers me, after reading this thread, is, “Why the heck do you guys call yourselves ‘liberals’?”
The original liberals, who must now go by names like “classical liberals” or “libertarians” to distinguish themselves from you, held/hold liberty to be man’s highest value. (Not necessarily the only one, but so essential to the satisfaction of other values that it has a special, paramount place.) So it made sense to call them “liberals”.
But modern liberals view liberty as just one of many values, and are clearly rank any number of those other values above liberty.
In part this might be due to this goofy definition of “coercion”, where simply offering to make somebody better off if they do as you ask is considered to be a form of coercion. By making ‘coercion’ omnipresent, you lower the threshold for resorting to it: Why not coerce, if coercion is inevitable?
Be that as it may, liberty isn’t your highest value, not by a longshot. So why do you cling to this name “liberal”?
Be that as it may, liberty isn’t your highest value, not by a longshot. So why do you cling to this name “liberal”?
Tradition ;-). And ‘Tolerables’ is already taken (what about ‘Tolerals’?).
And why should we give it up just because the window of definition shifted, I guess temporarily, to one side. Our views are imo still more in touch with the old one than those that these days call themselves conservatives*. And I doubt that your ideas about liberty are totally congruent with those in the late 18th century either.
*lots of libertines among them 😉
And while I am at it: the definition of ‘tolerant’ underwent massive changes too from ‘able to suffer’ over ‘willing to at least try to persuade those ignorant fools first (before I use violence)’* to ‘not using my power to enforce my own views’ to “accept the views of others as valid too’.
*I had to write an exam on different definitions of tolerance at school once. The older ones concentrated on ‘not suppressing the false views of others’ with ‘temporarily’ clearly often implied.
What bothers me, after reading this thread, is, “Why the heck do you guys call yourselves ‘liberals’?”
What Harmut said, plus the obvious caveat that some of us don’t call ourselves liberals, and take umbrage (mild or otherwise) when someone else takes it upon themselves to carelessly slap that label on us.
Liberal doesn’t come directly from liberty, it comes from the latin liberalis, meaning noble or generous. While it gets plugged into liberal arts because that denotes what one learns as a free man, the specific term of liberal is from the Enlightenment, meaning not liberty, but free from prejudice. That’s why it is hard to identify a ‘liberal’ view on kidney donation, because liberal can be seen as both granting the person donating that autonomy and being concerned that the choice is not really autonomous.
Ironically, the notion that there is a ‘conservative’ view of kidney donation that allows it in any way is a complete upending of the notion of conservative in terms of social mores (though if you want to claim that conservatives are more into recycling by virtue of their name, go for it, I’d like to see some of Bellmore contortion act that we’ve grown to view with amazement)
Also, it’s worth recalling that classical liberalism always put more emphasis on liberty as “freedom to” rather than “freedom from”. Not surprising given its generally bourgeois origins, but still. Those of us getting the liberal label lazily laid on us don’t necessarily agree with that emphasis… but then again, not all of us consider ourselves liberals, so that stands to reason.
So, people who oppose the sale of kidneys by living people do so, not because they rightly or wrongly think it might be a really bad idea likely to have grotesque and regretable consequences for some people, most likely poor people. No, it’s because they don’t value “liberty” higly enough. Because, really, what is liberty if one cannot sell one’s right or left kidney? It’s draconian, I tell you!
Argh, has obsidianwings turned into demonizing each other all the time?
It is totally ok to choose either side of this rather murky issue to talk about. But let’s focus.
If you want to argue that markets are inherently coercive–you can do so, but let’s be explicit about A) what you think the alternatives are, and B) why you think the alternatives are less coercive.
Many of you seem to want to argue that kidney donation represents a special risk. But apparently donating a kidney does not raise the risk of future kidney disease, and does not make the likelyhood of kidney disease being worse if you should get it later. (See for example this LAT article.)
So if you want to oppose kidney donation on something other than the ick factor (which you don’t for example allow for in the stem cell debate) we need to either find evidence that the practice really does expose the donor to unusual risks, or you need to talk about other reasons why you don’t like it.
I very much second Sebastian’s point here. This was what bothered me about Darth Revan’s post on the 31st(?), for example:
As it stands, I agree with publius that creating a legal space within which sale of organs is permitted would be a moral monstrosity which would victimise people who are poor, who have little content knowledge and little financial, intellectual or social capital.
The missing piece here is the question of whether giving up one kidney is actually bad, or to what extent. If it isn’t, or to whatever extent this is in doubt, then just saying that selling a kidney is this sort of “victimization” (with all the heavy reference to lack of content knowledge and etc. – like which content knowledge?) is simply wandering off into the entirely sure, famililar weeds. To make this sort of point, you’ve got to inescapably differentiate this sale and set it apart from, say, selling or pawning any possession at need or at will.
You needn’t be indifferent to or unconvinced by the poverty questions to run into this. Even for someone who, like Gary Farber (and me), would support a negative income tax (if the damn math/incentive/costs can be made to tip right) to put a floor on the possible coerciveness of poverty – the possible coerciveness of poverty to make you sell or pawn a valuable item does not add up to pointing at a negative conclusion about legally selling a kidney unless there is something wrong with selling a kidney on some other ground! (Unless you shouldn’t be allowed to sell other stuff in general that you wouldn’t sell if you didn’t have a strong reason or weren’t in a possible coercive corner?)
Answers to this health question should be a beginning premise for anyone, whichever way one’s argument goes. (Unless, for example on the “anti” said, one is willing to explicitly say, “Never mind the health question of giving up a kidney – entirely regardless, I want this illegal for reasons of pure disapproval or some other reason”) Vaguer talk of selling ALL your organs, or etc., doesn’t help either.
I should say that I like publius’ original standpoint still less than that sort of neglect of the actual medical question, if possible. Not to be needlessly harsh about someone else’s construction (there has been far too much of that in this thread), but his post really struck me strangely. As if one could really navigate, in regard to particular concrete questions, by these things called ideologies, which really ought to be, on an individual level, passively adjectival names applied to the varied cloudy mass of one’s individual judgments and trains of thought. No – as if those ideological generalities were the real subject. “It’s not this question… it’s all questions. And the notion that there is a line somewhere, in general, of some sort. Amid these ideological continents. This seems to me to be the crux.”
No, I think it’s the pros and cons and characteristics and concrete implications of the actual particular subject that should be all that are at issue. Because that’s where the decision is.
If the argument is that people will be exploited by kidneys sales, you could make the argument that the buyers are being exploited by the sellers. After all, a seller just needs the money whereas the buyer needs the kidney to stay alive.
So if you want to oppose kidney donation on something other than the ick factor (which you don’t for example allow for in the stem cell debate) we need to either find evidence that the practice really does expose the donor to unusual risks, or you need to talk about other reasons why you don’t like it.
First off, I’m not sure what you mean by “ick factor.” I’m not opposed to an open market on internal organs because I think organ transplants are icky. I actually find organ transplants, and the expertise that make them possible, quite fascinating.
Second, people HAVE been presenting reasons besides “the ick factor,” you have simply chosen not to address those. Or do you think inherent potential coerciveness of the market in which the less well off by are coerced into giving up their internal organs by the very well off, either directly or though third parties, is merely an “ick factor” rather than a moral issue?
Even if you chose to ignore those points, here’s another set of reasons, intrinsic to the transaction itself rather than dragging in those unimportant ancillary issues of consent and economic exploitation.
One, right off the bat: major surgery is always a high risk for the person being operated on. From the possibilities of adverse response to anasthesia to the risk of iatrogenic infection to the risk of just plain bad luck and dying under the knife.
The risk increases if the person being operated on has any pre-existing risk factors. I think we can make a good faith presumption that anyone so deperate for money that they’re willing to sell one of their internal organs has probably not had the best, say, nutrition and exercise regimen. There could be underlying systemic weaknesses, such as allergies, metabolic issues, etc. These are the kinds of conditions that someone with 2 working kidneys might be able to keep under control (please bear in mind what it is kidneys do, OK? They don’t just fill up the bladder with pee. They also help with electrolyte balance, which in turn affects such things as digestive system efficacy) but which might might no longer be controlled if there’s only 1 kidney doing the work of 2 kidneys.
Here’s another one, in the form of a question. The question is “Why do we have 2 kidneys in the first place?” (Along with 2 eyes, 2 lungs, 2 sex glands, 2 tonsils, 2 mammaries, etc etc) Why do we have 2 of those particular organs, and not 2 of everything (2 hearts would be really nice, don’t you think? Two livers, ditto. Two pancreas, gall bladders, pituitaries… maybe not 2 brains; we have enough trouble with single two-part brain we already have.)
Do we have 2 of those specific organs because God forsaw that some day we might want to have an open market in “extra” organs, and He was OK with that idea? Do we have 2 of those specific organs because the forces of natural selection favor redundancy for no particular reason?
You could say well, that’s why selling off one’s internal organs pays so well.
Except that, no, I don’t think there’s enough money around to make me want to risk serious metabolic/renal illness – if not directly after surgery, then very likely once I’m way over the hill and nothing is working quite as well as it did when I was younger and it sure would have been nice to still have that other kidney.
CaseyL:
The question of “inherent potential coerciveness of the market in which the less well off by are coerced into giving up their internal organs by the very well off, either directly or though third parties” considered as a standalone book-closer makes little sense – certainly not enough sense to make the challenge “even if you choose to ignore those points…” The question is whether, even under that general assumption that “poverty is coercive”, selling a kidney is sufficiently specially different, for some reason(s), than selling or pawning anything else that it should be treated differently than those other things. You mention health concerns later, but they ought to be here … unless anyone is supposed to succumb to this word-recipe of “markets are coercive!” just as it is read.
2. You make large assumptions about who would choose to do this. It wouldn’t necessarily be only the very most poor and therefore the most sickly. A lot of people might make this choice for the money. (For what it’s worth, that might broaden your intended point: a lot of people might conclude that they had to.)
3. The back-of-the-envelope reasoning you end with, that having one kidney rather than two must be bad because God/evolution gave us two, should have been left out – because this is a question susceptible of actual medical research and answers, and because that sort of “wouldn’t you think?” plausibility-reasoning has a lot of room to turn out to be actually completely mistaken. It’s a medical question. You don’t magically intuitively know the answer. Answer it with medical research results.
“I think we can make a good faith presumption that anyone so deperate for money that they’re willing to sell one of their internal organs has probably not had the best, say, nutrition and exercise regimen.”
I would strongly consider selling mine for anything over $50,000 (and there is some hint that the price might be more in the 80-100,000 range), and I’ve actually had good nutrition and exercise for at least the past 18 years. I don’t think you can make that presumption.
“Or do you think inherent potential coerciveness of the market in which the less well off by are coerced into giving up their internal organs by the very well off, either directly or though third parties, is merely an “ick factor” rather than a moral issue?”
There are some on this thread who have asserted that there is an inherent potential coerciveness to the market. I’ve suggested that it is no more inherent than many other important human arrangements such as families, governments, religious organizations, and in many cases general social groups–and in fact less so than those examples. Gary seemed to agree with that, no one else seems to have responded.
“Except that, no, I don’t think there’s enough money around to make me want to risk serious metabolic/renal illness – if not directly after surgery, then very likely once I’m way over the hill and nothing is working quite as well as it did when I was younger and it sure would have been nice to still have that other kidney.”
This seems to be in direct contradiction to the evidence that removing one of the kidneys is does not in fact subject you to an increased risk of metabolic/renal illness.
It is weird that you use that as an assertion in response to my comment when I deny that assertion in the very comment you responded to, and gave links that go back to the scientific evidence which support my contention. You could have responded with something like “perhaps the increased screening techniques are what cause those statistics” and at least try to engage the scientific evidence instead of ignoring it completely.
(Interesting meta-question: I didn’t come to the argument with much of a prior interest in selling kidneys. I’ve been arguing against what I see as rather bad arguments against it, and emotionally I feel much more wedded to the idea that it should be legal now. Is that an emotional response to defending something, or a real change in my considered position? Hmmm.)
On markets and coercion: markets exist to allocate limited goods as efficiently as possible. They provide efficient distribution and prevent free riding, both functions which require coercion. In cases where we can produce goods with little or no input from nature and find another way around the free rider problem, markets tend to change into something we would hardly recognize as a market: consider the open source movement, for example. So, while market economics seek to minimize coercion, because they deal with limited resources, classical markets do have an element of coercion, which we need to take into account when deciding what we will and will not trust markets to do.
As for kidneys: I agree that we ought to make organ donation on death mandatory for people without religious objections, the way the US government once made military service mandatory. Orthodox Jews and Muslims people with a note from the Rabbi or Imam would get a pretty automatic pass, while others would have to explain ourselves. I certainly think we should do that before allowing the buying of organs from live people.
As for why I don’t like live people selling their organs, the market minimizes coercion most successfully when all the participants have choices, what Roger Fisher called a best alternative to a negotiated agreement. If I won’t pay the Nissan dealer what he wants for a car, he can hang onto it and hope someone else will. If I can’t get the Nissan dealer to accept my price, I go shopping at Ford. Choices like that in markets maximize efficiency and minimize coercion. But from what I understand, kidneys don’t work like that. If the donor kidney does not match the recipient’s antigens pretty closely, then the transplant will not work, or at best the recipient will have to go through life with a severely compromised immune system. That limits the buyers, which in turn creates all kinds of moral hazards. What if someone’s kid needs a kidney, and the only matching donor won’t sell? If a parent in that circumstance had the power to ratchet up the economic pressure by getting the donor fired, denied loans, or otherwise economically compromised, how would you prevent that?
I’ve suggested that it is no more inherent than many other important human arrangements such as families, governments, religious organizations, and in many cases general social groups–and in fact less so than those examples. Gary seemed to agree with that, no one else seems to have responded.
I’ll offer a response.
The coerciveness of those arrangements and the arrangements themselves may be considered more necessary than the potential coerciveness of the market for kidney sales or kidney sales themselves, respectively. I don’t think any reasonable person would consider outlawing families, for example. You can’t really have society or even the human race without families, given the nature of human beings. You can have those things without living people selling their spare kidneys. Yes, for some kidney-needing minority, kidney sales would be a great benefit, but society and the human race can continue without them. So I think it’s a cost/benefit analysis weighing the costs of abuse and coersion a kidney market would bring versus the benefits to those in need of kidneys. You can disagree about that analysis, but simply comparing the various levels of coersion that exist in other areas of life to some assumed level of coersion in a kidney market is not relevent without considering other benefit or necessity factors.
(I don’t know what Gary’s response was, so I hope I’m not being redundant. I guess I could have checked first, but I’ve already typed more than I care to delete to go back now.)
And, that aside, I think plenty of people on this thread have make arguments that have nothing to do with “ick” or being indifferent to liberty.
Sebastian – It needn’t be a change in your position or just “defense loyalty”, necessarily. Depending on your feeling for freedom or legality, it might just be an unfolding consequence from a background premise: “if there’s no good argument for something to be illegal, it ought to be legal.” Certainly that sort of thing isn’t neutral or emotionless for me.
It wouldn’t be an inescapable premise for anyone in general, though. A lot of people may be going under a recipe (applied here and there) where they’d start with illegality being the presumption. Even without a good argument for illegality, there would apparently have to also be something else needed – maybe something actually impossible – for legality to sound right or even really be on the table. I’ve known a lot of people who have sounded like that, both “liberals” and “conservatives”.
“In part this might be due to this goofy definition of “coercion”, where simply offering to make somebody better off if they do as you ask is considered to be a form of coercion.”
Actually, Brett, it’s you who are making the assumption that there is only one term/condition to the offer, and that to simply consider whether, say, the offer offers money is the only term of the offer that must be considered. Whereas our position is that there may be several conditions to the offer beyond the single one of offering money.
For example, such an offer may be to offer a job requiring one to work in a company town: this involves more than just a salary, but also various restrictions on freedom. Ditto indentured servitude. Etc.
“By making ‘coercion’ omnipresent”
This, on the other hand, as I’ve previously claimed, is an untrue claim.
“Be that as it may, liberty isn’t your highest value, not by a longshot.”
That varies by individual. That it isn’t the only value for a modern American “liberal” is something that I agree is a fair statement, and is certainly true of me. It’s why I don’t consider myself a “libertarian” despite the fact that “liberty” is of extremely high value to me. It’s simply not the sole value I hold to be important. That “liberty” is the sole value worth considering does seem to be what defines most modern “libertarians” as such — or, at the least, that “liberty” in all ways must be the value that must always be the one of maximal importance. Libertarians seem to belive that “liberty” as a value always trumps any and all other values. Liberals do consider a balance of values, and how much “liberty” features in their personal balance set varies.
Feel free to correct me if you feel I have this wrong.
Sebastian: “If you want to argue that markets are inherently coercive”
I would not make that argument. I would argue that some transactions within a market can be coercive if there is too great a power imbalance between the parties.
That is, if it matters not at all in any matter of great importance to one side whether the transaction takes place, but to the other party, it’s a matter of, say, either accepting the offer, or starving one’s family, I would argue that that is a form of transaction that should be recognized as distinguishable from a market transaction where the results are of equal relative non-importance to both parties. And I don’t find calling the latter kind of transaction “somewhat coercive” even though I’d agree that strictly speaking it may not be.
But I’d rather not quibble over the label of “coercive,” rather than recognizing that the difference between the two types of transaction — a) a relatively balanced form of transaction in terms of results to both parties; and b) a highly unbalanced form of transaction where one party has a choice of either accepting, or serious suffering — is an important distinction.
“But apparently donating a kidney does not raise the risk of future kidney disease, and does not make the likelyhood of kidney disease being worse if you should get it later.”
I’m willing to stipulate that, but I’d note that giving up a back-up is just that, and not a negligible consideration.
However, note that my general position is that allowing some form of kidney (specifically, rather than considering a completely open market for all parties on all body parts) transaction may be acceptable.
(I’ve specifically noted that there are ways of allowing the party being compensated for the “sale” of their kidney without simply allowing the rich to purchase a kidney, such as allowing a donor to be compensated for by a third party which then distributes them strictly according to medical need.)
“And I don’t find calling the latter kind of transaction
‘somewhat coercive’ even though I’d agree that strictly speaking it may not be.”
Sorry: this should read “And I don’t find calling the latter kind of transaction ‘somewhat coercive’ bothersome, even though I’d agree that strictly speaking it may not be a ‘coercive’ transaction.”
John Spragge – I’m not sure of either of your objections you mention as a consequence of antigen-enforced limited buyers, at least as strongly affecting the answer here.
What if someone’s kid needs a kidney, and the only matching donor won’t sell? Well, at the moment no sales are possible, and the person who won’t sell the kidney evidently won’t give it free either. Which, unless I’m missing something, leaves us only where we are at present: hoping for a kidney from someone who has died and either getting it or not getting it. Allowing kidney sales opens up an additional possibility – admittedly not a certainty – of getting a needed kidney transplant. I don’t see how that would worsen the original picture, even if someone might refuse to sell.
If a parent in that circumstance had the power to ratchet up the economic pressure by getting the donor fired, denied loans, or otherwise economically compromised, how would you prevent that? … What, you mean evil or unlawful abuse of power? Presumably we would deal with this by law and the recourse to law, just as we do now. Do you really mean to say that, unless the possibility of powerful people abusing their power, ever, is completely resolved in society, kidney sales are closed – and this conclusion outweighs the benefits, any other benefits however prevalent, of increased access to transplant kidneys?
(By the way, I would also support the idea of making organ donation on death mandatory absent religious objections. But this needn’t contradict the idea of allowing people to sell their kidneys while they’re alive. It’s more certain that a kidney will be given, and in better shape, if it’s given live.)
For fun. John Thullen asked:
May I buy a human kidney because I enjoy a human kidney pie occasionally?
Why not?
My answer would be: That if it is legal to sell and buy kidneys for transplants – but in any case at all – then, yes, it should be legal to buy one because you want a snack. (The “may I” phrase confuses things. I presume this is a question about what the law should be, not asking us permission about having pie for lunch.)
My reason is that I don’t like and tend to actively oppose bans, inevitably punitive in nature, that are based on pure disapproval and nothing else. (What do you think?) And I don’t see any other reason involved, unless or until some reason against kidney sales for transplants – or, again, at all – did prove to be sound. (Caveat: If a surreal trend came through where the kidney supply for transplants started to dry up because of gustatory purchases, we could revisit the matter at that point. But not anticipatorily. Because it’s sort of unlikely.)
Mostly inspired by feeling a bit peckish at this point…
CharlesWT: “If the argument is that people will be exploited by kidneys sales, you could make the argument that the buyers are being exploited by the sellers. After all, a seller just needs the money whereas the buyer needs the kidney to stay alive.”
You’re not distinguishing here the crucial distinction between selling one kidney or both.
CaseyL: “One, right off the bat: major surgery is always a high risk for the person being operated on. From the possibilities of adverse response to anasthesia to the risk of iatrogenic infection to the risk of just plain bad luck and dying under the knife.”
Perfectly valid point.
“Here’s another one, in the form of a question. The question is “Why do we have 2 kidneys in the first place?” (Along with 2 eyes, 2 lungs, 2 sex glands, 2 tonsils, 2 mammaries, etc etc) Why do we have 2 of those particular organs, and not 2 of everything (2 hearts would be really nice, don’t you think? Two livers, ditto. Two pancreas, gall bladders, pituitaries… maybe not 2 brains; we have enough trouble with single two-part brain we already have.)”
The answers vary here: we have two eyes so as to give stereo vision (I am acutely aware of this, as I have amblyopia, which although the appearance was surgically corrected when I was around 5 years old, still means I lack stereo vision).
Two lungs gives us better oxygen absorption than one. As for the rest, IANAdoctor, so I’m not sure if they’re just spares or helpful, or what.
In the case of a kidney, so far as I know, it’s just a spare.
Klingons have two hearts, and other redundancies! I know you wanted to know that.
Alex Russell: “The question is whether, even under that general assumption that ‘poverty is coercive’,”
As above, I think a better formulation isn’t that “poverty is coercive” as that “some transactions made when suffering poverty offer a greater number of unattractive options than the number of options that a well-off person is limited to.”
Or, shorter, “poverty offers more transactions that are closer to coercive than being rich does.”
Sebastian: “There are some on this thread who have asserted that there is an inherent potential coerciveness to the market.”
I may have missed it, but I don’t recall noting that save as a mischaracterization of a more narrow claim.
“This seems to be in direct contradiction to the evidence that removing one of the kidneys is does not in fact subject you to an increased risk of metabolic/renal illness.”
CaseyL’s points about the risks of any surgery are relevant.
John Spragge: “As for kidneys: I agree that we ought to make organ donation on death mandatory for people without religious objections, the way the US government once made military service mandatory.”
I’m okay with that, although simply making it the default option unless you specifically leave a legal document stating you object might preserve greater “liberty.”
“As for kidneys: I agree that we ought to make organ donation on death mandatory for people without religious objections, the way the US government once made military service mandatory.”
Again, see the notion of interceding with a third party, so that there’s “selling” (or “compensation,” if the language makes a difference) of a kidney, but not buying of a kidney. That eliminates some objections, such as the matching question, and the question of richer people benefiting more than others, but doesn’t necessarily eliminate all objections to compensation for kidney donation.
On the other paw, such a third party eliminates competition in terms of compensating the donor, for what it’s worth, so there’s arguably a downside to that option, too.
hairshirthedonist: “Yes, for some kidney-needing minority, kidney sales would be a great benefit,”
Such as living, rather than dying. That’s a pretty great benefit to an individual, though not up to the level of “survival of the human race,” which is a pretty high bar to need to pass to find an option allowable.
“Do you really mean to say that, unless the possibility of powerful people abusing their power, ever, is completely resolved in society, kidney sales are closed – and this conclusion outweighs the benefits, any other benefits however prevalent, of increased access to transplant kidneys?”
You should note that the argument actually would be that until the possibility of powerful people abusing their power, ever, is completely resolved in society, all sales of anything are closed.
And even if you don’t accept that extension (though it isn’t clear at all why the argument would be self limiting to avoid that extension) you then need to notice that there are other forms of abuseable power that aren’t economic: say governmental power, for example. We’ve all seen examples of policemen abusing their power for example. So perhaps we shouldn’t allow any government power until all possible abuses of it are excised from the system?
Gary, “But I’d rather not quibble over the label of “coercive,” rather than recognizing that the difference between the two types of transaction — a) a relatively balanced form of transaction in terms of results to both parties; and b) a highly unbalanced form of transaction where one party has a choice of either accepting, or serious suffering — is an important distinction.”
Ok, but you seem to suggest that such an imbalance only cuts against the poor. But in this particular case the transaction is also VERY important to the person who needs a kidney transplant. It isn’t obvious at all that the poor person is dramatically unbalanced in power in comparison to the sick person for the purposes of this transaction. The kidney transplant person will die!
Also, the number of people with healthy kidneys who will literally starve to death in the US without selling their kidney is very small (quite probably zero). Now you might be worried about incentivizing kidney harvesting in Somalia, which could be dealt with by an import ban.
“My reason is that I don’t like and tend to actively oppose bans, inevitably punitive in nature, that are based on pure disapproval and nothing else.”
I don’t think that’s necessarily the case in distinguishing between selling a body part to save someone’s life, and selling a body part for someone’s dining pleasure. I think distinguishing between what’s allowable, when it increases the risk of bodily harm to one party (which surgery inherently does), and what’s not, is irrelevant.
“My reason is that I don’t like and tend to actively oppose bans, inevitably punitive in nature, that are based on pure disapproval and nothing else.”
What CaseyL said: iatrogensis, which is to say, physician error, risk of adverse reaction to anesthesia, and risk of infection, are real risks, no matter how arguably small. Simply weakening your immune system and being in a hospital environment during that period is not a completely negligible risk.
From my link:
I don’t think these are risks that themselves rise to the level of themselves mandating a ban on a kidney transaction, since they’re not overwhelmingly strong risks — we allow trivial cosmetic surgery, after all — but they’re not negligible, either. What risks to individual choices we as a society should legally ban is, of course, a general question of public policy that frequently arises. (See smoking in bars and restaurants, helmet laws, seatbelt laws, etc., etc. This is, as we all know, sometimes referred to as to how much of a “nanny state” we wish to live in.)
Alex Russell: “The question is whether, even under that general assumption that ‘poverty is coercive’,”
As above, I think a better formulation isn’t that “poverty is coercive” as that “some transactions made when suffering poverty offer a greater number of unattractive options than the number of options that a well-off person is limited to.”
*nods* Good.
Gary: “Sebastian: “There are some on this thread who have asserted that there is an inherent potential coerciveness to the market.”
I may have missed it, but I don’t recall noting that save as a mischaracterization of a more narrow claim.”
Well publius begins it with his post: “I can’t quite justify it, but the inherent coercion on poorer people seems like a bigger deal when we start trying to commodify body parts.”
This is continued with July 31 11:25 “Occurs to me that all markets are coersive by their very definition, so are you not arguing that the level of coersiveness is the problem?”
Von and I argue against this proposition, but it is met with favor from Jesurgislac, and you apparently argue against me arguing against it at the beginning of the thread, but then after I clarify you agree with me on the issue.
“CaseyL’s points about the risks of any surgery are relevant.”
Which is why I suspect that the price won’t ever go as low as say hair weaves.
Gary: I have no strong desire to pursue the advocacy of cannibal rights very far as opposed to the transplants question, but I don’t think it follows, or at any rate I don’t follow you, that because there is some risk from surgery, which you point out and which I certainly do not contest – or because there is some risk from a given activity – but it does not happen to be counterbalanced by a special strong social benefit like availability of transplant organs, that that activity should therefore be illegal while the transplant purpose should be legal.
We accept risks all the time for all kinds of reasons. Some of the things we do quite voluntarily are quite risky. I’m not in a mood to sell my kidney, but, if I were, I don’t think I would care why someone would want to pay me $75,000 for it. The money would be the reason for the risk. A lifesaving transplant reason would be an additional positive reason, but, on the negative side, it would be up to me whether I cared why. (Or whether I were willing to eat shallots for a week before the extraction.)
You don’t pick up the disapproval angle, but the missing underlying reason why the surgical risk would decide this question so completely would indeed be disapproval about the kidney pie… unless a truly remarkable number of activities are going to be banned for risk factors. As you say, these boundaries are very much in democratic play, but that doesn’t mean that we can’t apply our own filters to try to figure out when that play is or isn’t right. Me, I first read On Liberty when I was eight. :o) It makes one slow on the urge to ban.
Anyway, back to the engrossing medical-benefit/cost talk, unless someone else is feeling hungry.
When my mom passed away, I had several of her body parts preserved as reminders. Not.
But this hopefully illustrates that the integrity of one’s body is not the same as someone not liking mushy peas or people putting a wet spoon in a bowl of sugar.
There was a Robbie Williams music video that caused a huge uproar, where the singer, after getting no reaction from the crowd, starts stripping himself of his skin, muscles and organs and tossing them out to the now adoring crowd.
Also you seem to have this notion that coercion is an unalloyed evil and publius suggesting that all markets are coercive is revealing. I’d suggest that there are very few people who feel that coercion is something that is always evil. As a teacher, I ‘coerce’ all the time, and if the students don’t want to be coerced, they are welcome to quit school. I also work with the other teachers teaching the same class to make sure that the main requirements are not just in my class, but in all the classes. By the mere fact that we have to assign grades makes the arrangment ‘coercive’, but just because people concerned that extreme poverty might be overly coercive does not mean that they want to abolish all coercion.
If publius and other commenters here are using ‘coerce’ to mean something that isn’t negative, I’m not sure what they mean.
And if they are saying that it is ‘overly coercive’ I would like to know what goes into the calculation. Usually the fact that the procedure is likely to save a life, and very unlikely to risk another life, would at least be a very strong argument in favor.
Perhaps a black and white definition of coercion is part of the problem you are having here. Coercive means ‘using force or _authority_ to make someone do something’. He then points out, as you quote, that markets are coercive and it is a problem with the _level_ of coerciveness. Taking a drug to suppress one’s immune system is negative, but I don’t think that if I note that, I am against any and all administration of such drugs.
Ok, but you seem to suggest that such an imbalance only cuts against the poor. But in this particular case the transaction is also VERY important to the person who needs a kidney transplant. It isn’t obvious at all that the poor person is dramatically unbalanced in power in comparison to the sick person for the purposes of this transaction. The kidney transplant person will die!
I’m reminded here of a scene from It’s A Wonderful Life, with Mr. Potter and George Bailey conversing in the former’s office, only in reverse. “Well, it seems that suddenly poor people and their internal organs have become very important to you, Mr. Potter . . .”
hairshirthedonist: “Yes, for some kidney-needing minority, kidney sales would be a great benefit,”
Such as living, rather than dying. That’s a pretty great benefit to an individual, though not up to the level of “survival of the human race,” which is a pretty high bar to need to pass to find an option allowable.
To be sure. But I was responding specifically to Sebastian’s argument that other allowable things are at least as coercive as markets, therefore coercion in kidney markets isn’t a valid reason to oppose kidney markets. And allowing kidney sales is not the only option available for saving lives of those in need of kidneys, nor is it a guarantee of prolonged life for everyone who needs a kidney. I’m sure it would be for at least one and very likely many more of those in need of kidneys, but the issue is none-the-less one of trade-offs. Pointing to the coercive costs of other entirely different things while ignoring the differences in the trade-offs isn’t valid as a comparison. That’s really my point. I really can’t say for sure that kidney sales wouldn’t be a net good, but I’m inclined not to think so, perhaps with less certainty than a few days ago.
Publius didn’t there make any such broad claim; as I wrote, he specifically made “a more narrow claim.” He quite specifically says “when we start trying to commodify body parts.”
Your second quote is from one Barrett Wolf, who did make the claim, but that’s one person, not “some on this thread.”
Alex: “…that that activity should therefore be illegal while the transplant purpose should be legal.”
I wasn’t making that case; I was making the case for considering the two — cannibalism, and saving lives — as a distinction worth making in an argument. I didn’t go on to make the argument you refute in what I just quoted.
LJ: “…publius suggesting that all markets are coercive is revealing.”
Again, publius didn’t write that. He wrote: Just as liberalism’s goal was to carve out a realm of freedom from the state, it’s also important to carve out realms of freedom from coercive market logic.
Market failures are a different issue. I’m sure a market for kidneys would work pretty well. I’m just not sure I want market logic – which is necessarily coercive on some more than others – to intrude into the realm of body parts, or selling children. The only person on this thread I’ve noticed making the claim that “that all markets are coercive” was Barrett Wolf.
I’m not following how Barrett Wolf’s opinion is “is revealing” as to what publius thinks, unless publius has adopted another pseudonym.
“As a teacher, I ‘coerce’ all the time, and if the students don’t want to be coerced, they are welcome to quit school.”
That’s not coercion; they can, as you say, quit school, and there are plenty of other schools in Japan, are there not? You set down requirements that your students either agree to abide by, or don’t agree to, and go elsewhere. And if there’s a parallel to the degree of, say, having to sell a kidney or not have money for food, I think you’d have to make a case for that.
Sebastian: “Usually the fact that the procedure is likely to save a life, and very unlikely to risk another life, would at least be a very strong argument in favor.”
I agree with that.
LJ: “Perhaps a black and white definition of coercion is part of the problem you are having here. Coercive means ‘using force or _authority_ to make someone do something’. He then points out, as you quote, that markets are coercive and it is a problem with the _level_ of coerciveness.”
Who “he”?
What I should have been more clear about was that Sebastian was comparing kidney sales to things that are necessary for the survival of the human race, or at least that have been inextricable from that existence for all of human history (i.e. families, religion – I mean, really? Those things and kidney sales?).
This should have appeared in block quotes as a quote from publius, in my above comment, rather than my having not realized I failed my blockquote attempt:
Sorry for any confusion.
“On markets and coercion: markets exist to allocate limited goods as efficiently as possible.”
You’d almost think some group of sages got together to design a mechanism for the efficient allocation of limited goods, and then decided to call it a market. At least, from the way you’re describing it.
Don’t be silly: Markets don’t exist to, they exist because, they weren’t intentionally created. They’re the natural result of people having things to exchange, and being obstructed from exchaning them by theft or plunder.
“Actually, Brett, it’s you who are making the assumption that there is only one term/condition to the offer, and that to simply consider whether, say, the offer offers money is the only term of the offer that must be considered.”
I made no such assumption, either implied or explicit. The key point is that an offer is an offer, that is to say, the person making it isn’t going to afirmatively act to make you worse off if you don’t agree to it. They’re just going to walk away, leaving you as you were.
You, hanging from the edge of a crumbling cliff:
1. Somebody comes by, and says, “I’ll haul you up from there if you’ll agree to pay me $100.”
2. Somebody comes by, and says, “Pay me $100, or I’ll stomp on your fingers.”
One is an offer, the other a threat, and some here seem committed to obscuring the difference.
Gary, I think the definition of coercion you may have in mind suggests that a person has no other alternative other than what they are forced to do, either by force or authority. I’m not sure how precisely this is defined, but this seems a bit too strong, because stating that there is no alternative removes the notion of some sort of cost/benefit relationship. A quick google pulls up this, which I toss out in hopes of encouraging one particular philosopher to comment.
Also, you asked “Who “he”?”
Thanks to your correction, I see it was Barrett Wolfe, who Sebastian quotes from July 31, 11:25, I had misread it as Sebastian quoting publius. Sorry about the confusion.
“Don’t be silly: Markets don’t exist to, they exist because, they weren’t intentionally created. They’re the natural result of people having things to exchange, and being obstructed from exchaning them by theft or plunder.”
This is nonsense, and completely untrue. If you read a little anthropology, you’ll run across the fact that many societies, past, and some non-industrial, small-scall, societies in the last century, have functioned on entirely different economic bases, such as regarding property as communal, or mutual. See, for instance, the British Commons, many of the ways many Native American tribes have dealt with various forms of property, including not believing in an individual right to land, but holding it communally by the tribe, and so on and so forth.
The fetishizing of “the market” as the only “natural” possible human arrangement is a basic error of fervent libertarians, because it’s based on an assertion/understanding about human nature that is demonstrably untrue.
Markets are one economic arrangement humans have invented, but they’ve invented a variety of others that have worked for their cultures as well.
LJ: “Gary, I think the definition of coercion you may have in mind suggests that a person has no other alternative other than what they are forced to do, either by force or authority.”
Give the number of comments I’ve made on this thread stating exactly the opposite, this seems like a very peculiar response.
“Give the number of comments I’ve made on this thread stating exactly the opposite, this seems like a very peculiar response.”
To be a little more precise, that should be “Give the number of comments I’ve made on this thread stating largely the opposite, this seems like a very peculiar response.”
Strictly speaking, your quote is the only strict form of “coercion,” and I’ve made comments that have acknowledged that, while the gist of most of my comments have been arguing that less strict forms of usage are important to acknowledge, whatever we call them. If you need quotes from my previous comments, I’ll collect them, but maybe not tonight, when I have to keep connecting and reconnecting to the internet every couple of minutes.
Gary, I’ve glossed over large parts of this thread, so I haven’t attended to all the ins and outs of defining coercion but I was specifically addressing your remarks (at 8:30pm) made to me concerning the notion of ‘coercion’ in education. I would acknowledge that it is a bit on the radical side to view grading as coercion, but that’s how I roll.
As for the facts of university schooling in Japan, a university student who opts to quit school rather than submit to what I want them to do must, in order to get into another school, take another entrance exam (transferring only occurs if the two schools have a specific agreement), and, in opting to do so, don’t get to transfer any of their previously earned credits. (there is a separate category of tests for transfer students, but it is quite restricted in terms of applicability) In addition, students pay an ‘entry fee’, separate from tuition, so one must consider those as sunk costs. There are a range of other considerations that make my decision to fail or pass much more ‘coercive’ than the corresponding course in a US university.
I would certainly acknowledge that a US teacher doing a 101 course at a State U is much less guilty of coercion, but the key element, at least to me, of coercion, is substituting your will for the will of the target. One may have excellent reasons for wanting to do so, but I have always thought that this was the primary point behind coercion. So please don’t go to any trouble citing previous comments unless you think that they are related to something specific in the educational context or specifically argues against that point about coercion.
Trackback doesn’t seem to be working, but I posted what I think is a fairly solid rebuttal back at my blog. Shorter version: You’re attributing a constant (the poor have limited options because they’re poor) to a variable (whether or not they’re allowed to sell kidneys). You can’t do that because it’s a constant. Restricting kidney sales doesn’t magically give the poor more options–it just takes away an option that some would prefer to have.
By the way, does your blog offer a way to view all posts by one particular author?
Gary:
You may be defining “markets” too narrowly. Exchange, i.e. markets, exist in all human societies. More explicit in some than others. The societies wouldn’t exist otherwise.
I would also argue that markets are not an invention, but an emergent order.
If the poster is using a TypePad login, clicking on their handle will give you a listing of their comments.
“Gary, I’ve glossed over large parts of this thread, so I haven’t attended to all the ins and outs of defining coercion but I was specifically addressing your remarks (at 8:30pm) made to me concerning the notion of ‘coercion’ in education.”
Yes, well, I’ve made a great many other relevant comments that should affect your belief as to what I believe about coercion, if you’re interested.
“There are a range of other considerations that make my decision to fail or pass much more ‘coercive’ than the corresponding course in a US university.”
Thanks for explaining that. In any case, what I “have in mind” as what does and doesn’t constitute coercion, I’ve already explained at length in this thread, rather than in a single comment to you. I understand that you may not be sufficiently fascinated, or have the amount of time, necessary to read what I wrote, but it would actually give you a more accurate notion of what I “have in mind.”
For instance, at July 31, 2009 at 12:31 PM, I wrote:
See also, if interested, my July 31, 2009 at 12:47 PM; July 31, 2009 at 12:49 PM; particularly my July 31, 2009 at 02:05 PM; my July 31, 2009 at 02:11 PM; my July 31, 2009 at 02:13 PM; particularly my July 31, 2009 at 02:14 PM; my July 31, 2009 at 02:42 PM; my July 31, 2009 at 03:07 PM; and most especially the following five comments out of them all (and I’ve left out listing the other, non-relevant to this issue, comments I’ve made on this thread, of course), this one at July 31, 2009 at 05:06 PM, with July 31, 2009 at 05:13 PM coming in second. with my link to the Ludlow massacre as explaining the kind of “coercion” involved in “choosing” to live in a company town, and July 31, 2009 at 06:16 PM coming in third, and August 03, 2009 at 05:07 PM about equally, along with August 03, 2009 at 05:37 PM.
The first set of comments I made are relevant to my views on coercion, but the last five I list there should make my views in this regard clearest, I hope.
To quote myself in that last:
At July 31, 2009 at 05:06 PM I wrote:
In the July 31st, 6:16 p.m. comment, I wrote:
Lastly, my August 03, 2009 at 05:07 PM is too long to quote again, but again goes at length into my views on “coercion,” and I’d really suggest reading it if you really want to know my view.
If you read these comments, I think you’ll understand why I found your summary of my views bizarre, given how much I’ve said to contradict what you stated you believed I “have in mind” on the subject by paying attention to just one simple short comment; I didn’t think I needed to recover ground I’d covered over and over and over again in this very thread.
Thanks for any patience you bring to this; I appreciate that catching up or tracking a very long thread is very time-consuming, to be sure, and I’m not trying to suggest you did anything Bad, immoral, or fattening, by skimming. I’m merely explaining why I was so confused by your response.
Brett wrote:
CharlesWT wrote:
If we permit selling of kidneys, that selling (and buying) will probably take place within what we call markets today, defined, among other things, by a state-issued medium of exchange and rules of measurement and disclosure. Markets, in that sense, evolved out of both individual and government decisions. Experience shows that in cases where exchanges require no coercion (i.e. free riders do not pose a problem, and the goods to distribute meet or exceed the demand), many people will abandon the market mechanisms in favour of more informal means of sharing and interacting.
Alex Russell wrote:
Since powerful people abuse their power, we work to figure out which aspects of the market lets themselves to abuse or motivate abuse, and minimize those aspects. I would also point out that your argument contains an unspoken and unjustified assumption: that a market mechanism provides the only way to increase access to transplant kidneys. I have already proposed one way of increasing the supply of donor kidneys: making donation mandatory (or at least the default). Other methods might include providing a public health package for living donors who choose to donate, including priority access to a donated kidney if the remaining kidney packs up, free medical care, and above all the assurance that a living donor kidney will go to the person with the greatest need, not the thickest wallet.
There are all kinds of markets. Rush hour traffic is a market in time. A large number of people have decided that it is worth spending a certain amount of their time to drive their car in a particular geographical area during a particular time of day. There are occasional market failures due to weather, traffic accidents or the president comes to town and you are forced to spend a great deal more than you intended to.
An example of a non-monetary market. But, then, time is money.
And then there are the bar and nightclub markets. Are those “meet” or “meat” markets?
Gary,
Thanks for the explanation of your views. I’d first hasten to point out that I wrote about “the definition of coercion you _may_ have in mind”. I try, especially when you are involved, to avoid mindreading, and I’m sorry if this phrasing doesn’t adequately express my attempt to avoid suggesting that I know precisely what you mean when you write
“That’s not coercion; they can, as you say, quit school, and there are plenty of other schools in Japan, are there not? You set down requirements that your students either agree to abide by, or don’t agree to, and go elsewhere.”
If you go to the Stanford Encyclopedia of Philosophy article I mentioned, you will see that there are are those who take many of the points you make about coercion. However, there are a few points from the article that might be of interest.
The first is this
“Sometimes the term “coercion” is used in popular speech with a quite broad sense. For instance, one hears “coercion” used to describe social pressures (e.g., the need to conform to peer expectations or to placate one’s parents); or the constraining or manipulative effects of advertising, one’s upbringing, or the structuring of society more generally (e.g., the necessity of participating in a capitalist economy). It is also sometimes treated as a quite general concept encompassing almost any sort of interpersonal infringement on one’s rights. Such uses are not wholly foreign to philosophical discussions (see, e.g., Ripstein, 2004). Nonetheless, the following discussion will focus on a narrower sense of the term more in line with its use by major historical philosophical writers and contemporary theorists alike. This usage will rule out, by stipulation, such things as mere disapproval, emotional manipulation, or wheedling. (What is “ruled in” is subject to dispute, as is discussed below.) This minimal setting of boundaries still leaves considerable room for disagreement over how best to understand coercion’s workings, its preconditions, and its effects.”
If one accepts a definition of coercion as encompassing the utilization of an institutional framework to force a person/persons to commit certain acts, school is coercion, even though students can, as you point out, quit school or transfer. You stated that you accept Sebastian’s formulation that
“I’m not arguing that it is impossible for any market anywhere to be coercive. I’m arguing against the idea that markets are by nature coercive. They aren’t. They are much less coercive ‘by nature’ than most human institutions. Can they be used in a coercive fashion? Sure. But are they definitionally coercive? No. And they are less definitionally coercive than governments, families, and most religious structures.”
I’m not sure precisely what Sebastian’s definition of coercive is, though I tend to think that the adjective can encompass a wider range of situations than the noun, so that something can be coercive, but if it fails to force the coercee to change his/her behavior, it is not ‘coercion’ per se. As I mentioned, my own definition of coercion is where the coercer substitutes his/her will for that of the coercee, which is why I haven’t participated too much the kidney debate here because I think one knows too little about the will of the participants.
This definition goes further than yours concerning power imbalance as defining coercion, but I feel more comfortable with that than trying to define what power imbalance is sufficient to define something as coercive. But I think even this definition encompasses my own feelings about how most modern day education is inherently coercive, because the power imbalance between the teacher and the student seems to be large enough to be covered by your definition. At any rate, I don’t think that coercion is definitionally immoral, just that it requires extra scrutiny because it is so powerful. However, I do feel that while coercion is not inherently immoral, exploitation is, so my problem with kidney sales is that there seems to be far too much scope for exploitation. This 2004 WSJ article may be of interest.
I’m interested in discussing coercion in this light, but it is admittedly orthogonal as to whether kidney sales are coercive.
My definition of coercion is that it takes place when the coercer threatens, if the coerced does not comply, to make the coerced worse off than if the two of them had never interacted. The threat may be implied or explicit, but it must exist.
Simply making an offer, and walking away if it is not accepted, can NEVER be coercion.
You can, of course, exploit somebody’s pre-existing circumstances, in a non-coercive manner. But that’s something different, and is, essentially, the basis of all transactions. Hell, Burger King does THAT to me, when I’m hungry.
“Hell, Burger King does THAT to me when I’m hungry.”
I find THE Burger King, the one in the commercials with the smile frozen on his face, extremely threatening.
When he leaves the screen, I check to see if I still have both of my kidneys.
All the definitionalism regarding what is or is not “coercion” seems to be getting off the rails a bit. Isn’t it fairly clear that what we’re discussing is poor people being far more likely than others to do something highly regrettable for financial reasons? Whether that constitutes coercion or not, people can think that it’s a problem sufficient to oppose the sale of kidneys.
So the question is: Is that a moral and/or practical problem with kidney sales that outweighs the potential benefits? (There may be other questions, as well. But I think that’s “the” question when it comes to the concern regarding the possible effects on the poor, coercion or not.)
“Isn’t it fairly clear that what we’re discussing is poor people being far more likely than others to do something highly regrettable for financial reasons? Whether that constitutes coercion or not, people can think that it’s a problem sufficient to oppose the sale of kidneys.”
I keep trying to address this. The problem is that the scientific evidence doesn’t seem to suggest that it is *in fact* highly regrettable. People who donate kidneys now don’t seem to have a higher risk for future kidney disease or failure than those who don’t donate. They don’t seem to have a higher mortality rate if they do get kidney disease.
So it doesn’t look like giving a kidney up actually is highly regrettable unless you are talking about some sort of non-health thing.
I suspect that for a lot of people the issue really isn’t a health issue. I suspect that a lot of people have a visceral reaction to the idea that isn’t really about the health outcome of the kidney donor. And that’s fine. I’m actually very open to the idea that visceral reactions are worth attending to. But we can’t even start looking at it with everyone claiming to be worried about the health of the donor (health of the kidney patient mostly sidelined or hand-waved in this discussion except by Gary) when there isn’t much if any evidence that the donor is in much actual danger.
Is it absolutely definitely ZERO actual danger? No. But very few human activites have absolutely definitely ZERO actual danger, and many jobs that the poor end up taking have at least as much annual danger as giving up a kidney.
The problem is that the scientific evidence doesn’t seem to suggest that it is *in fact* highly regrettable.
Perhaps that is the case. I’m just trying to point out what argument should be had, as opposed to niggling over what the word “coercive” means or how well it applies to something that is pretty well understood, regardless. At this point, I’m not arriving at a conclusion, just trying to clarify what I think the argument is. Of course, I could be wrong about that, too.
Regardless of the appropriateness of the use of the word “coercion” some people think kidney sales would present a big problem for poor people desperate for money, and others, including you, Sebastian, don’t. So forget about coercion and discuss the problems directly (which is what you were doing, BTW, Seb, so I say keep it up – though the tread is probably dead, anyway).
” Isn’t it fairly clear that what we’re discussing is poor people being far more likely than others to do something highly regrettable for financial reasons?”
What, like taking a shitty job? Like living in a rat infested apartment? You’re not offended by “coercion”, you’re offended by “poverty”. You don’t have to subsume all the evils of the world under one word, you know.
John Spragge – No, actually my argument does not contain the assumption that a market mechanism is the only way to increase access to transplant kidneys. It is not there. (After all, my very next sentence after the one you quoted was, “By the way, I would also support the idea of making organ donation on death mandatory absent religious objections.” By “also” I mean not just alternatively but potentially simultaneously.) My idea has been that kidney sales are a way to increase the transplant supply, that would add up to a net benefit.
I have no objection to your other suggestions, either, although the suggestion of offering free medical care, a public health package, etc. wouldn’t jibe well with my own preferences – because I’d support a universal health care arrangement, not just for them but for everyone, which would seem to address a lot more unfair unequality than banning kidney sales would.
I’m afraid I can’t join you on your special focus on powerful people abusing their power and people with thick wallets. Whatever alternative arrangements were in place or were simultaneously in place, the difference between banning kidney sales and allowing them would never be zero; it wouldn’t be a matter of an available kidney being just as available but simply having become available by one route or the other. Cash offers motivate people as other things will not. (The matter of the money going to the people who would want it is not a neutral or a negative matter either.) The effect of banning kidney sales, as opposed to not banning them, is that some people who could have paid for a kidney will not get one, and some people who were willing to sell one for the significant amount of money will not get the money. In the vast majority of these cases, no such abuse of power as you described the possibility of would have been involved. I cannot find this result preferable.
This focus on special abuse of wealth and power being the determining factor here reminds me of what I have thought of as bad examples of reasoning about the possibility of legalization of marijuana or other things, where people have fixed on particular possible results of the new arrangements or things that might happen under it – somewhere, sometime – and, because they find those things intolerable, declaring the entire regime an unsound idea – completely without reference to the rarity or unlikelihood or partiality or pure hypotheticality of the intolerable case they have fixated upon. But I don’t think I’ll persuade you about what you’re finding central here. I’ll just say that I’m concerned with the general effect.
Brett-
I found your example of the person hanging off the cliff very useful. One thing I get from it is that the people talking about markets being coercive on poor people probably mean mostly that the situation is coercive – the cliff is coercive. Or at least this is most intelligible, but it probably lines up well with their sense of things.
I can understand this. What’s fascinating is the reactions to the problem. I can understand Gary’s mention of a negative income tax arrangement, as a response, because this would address the coerciveness by shallowing the cliff or making it less steep (all possible cliffs). There’d be more of a limit on what kind of a corner people could be in. The math is tricky and might be unworkable, but in intent this is comprehensible.
What I find amazing in this conversation, though, is that people are wanting to address and apparently combat the coerciveness of the cliff you’re hanging off of by forbidding you to pay a passerby to lift you out of the trouble. Precisely because you have to pay, and calling that the coercion. And looking askance at the passerby for being open to the deal… as if s/he is the coercer – the cliff.
I’ve been polite to the coercion frame in this thread, on an “even if” basis, because I do believe in cliffs from time to time. But the rest of the way this is picked up is a bit confused.
(John Thullen – No kidding, the new Burger King guy makes my @#$%&* blood run cold.)
Thanks for your expansion of your views, liberal japonicus. I notice nothing significant I disagree with.
Brett: “Simply making an offer, and walking away if it is not accepted, can NEVER be coercion.”
That, of course, I disagree with. You simply assert it. It’s an article of faith with you. That’s nice.
JT: “I find THE Burger King, the one in the commercials with the smile frozen on his face, extremely threatening.”
Me, too. If I were in a focus group on any of those commercials, I’d explain that that plastic thing frightens me inexplicably. Perhaps it’s an “uncanny valley” effect, although the plastic doesn’t seem all that close to human to me.
Incidentally, everyone who is really, really concerned about helping people in need of kidneys get them can go right here and give one of yours to a compatible donor right now.
Silly Phil, the point isn’t that people are suffering for want of kidneys: the point is that demanding organ markets allows conservatives and libertarians to feel good about themselves by claiming that liberals are fuzzy headed. I mean, if they actually cared about the organ shortage, we’d see serious proposals like making organ donation opt-out rather than opt-in or special tax breaks for everyone with an organ donor card.
@Sebastian:
I keep trying to address this. The problem is that the scientific evidence doesn’t seem to suggest that it is *in fact* highly regrettable. People who donate kidneys now don’t seem to have a higher risk for future kidney disease or failure than those who don’t donate. They don’t seem to have a higher mortality rate if they do get kidney disease.
This neatly elides the fact that we are talking about paying would-be donors to undergo major intrusive surgery. As has been mentioned upthread repeatedly. Declaring kidney donation to be of negligible risk by focusing strictly on the ability to survive with a single kidney if all goes well with the donation is slightly disingenuous.
Turbulence, I’m a liberal by just about any sorting, and I would support the opt-out arrangement – in fact more than that – and etc. … and there is an argument for kidney sales that is about the transplant supply.
And Obsidian Wings is where I come when I want to see something other than accusations that someone else’s arguments are only about the other side wanting to feel good by slamming their other side. Perhaps optimistically, but then again often here the focus really is on people’s arguments on their merits.
“Silly Phil, the point isn’t that people are suffering for want of kidneys: the point is that demanding organ markets allows conservatives and libertarians to feel good about themselves by claiming that liberals are fuzzy headed.”
I thought the point was to let liberals feel good about themselves while pretending to care deeply about protecting the poor people that they hurry by on the street every day.
Or maybe we are actually trying to have a good discussion about the issue without name calling.
I’ve linked to the science which suggests that kidney donation, if screened for general health, doesn’t increase risk for further kidney disease.
So, as science-respecting policy people are you all dropping that particular concern, or at least questioning it seriously? Or is there something else going on?
I’m going on with the argument assuming that the science is correct.
Since kidney donation does not appear to cause increased risk of kidney disease, kidney sale should not be banned on the grounds of being unfairly exploitive in the long term. The benefit to the kidney patient is enormous. The benefit to the kidney donor is the money received. The long term detriment appears to be zero or vanishingly small.
So the question shifts to short term issues. I don’t know exactly what the short term surgical complications risk is–but in general I would suggest that if it is in the same risk zone as an elective surgery like a breast implant surgery, that it doesn’t make sense to outlaw it on that basis either.
Is there evidence that it is substantially more risky than elective procedures that we let people pay doctors for?
“I’ve linked to the science which suggests that kidney donation, if screened for general health, doesn’t increase risk for further kidney disease.”
And I’ve linked to the stats on iatrogenesis. So, So, as a science-respecting policy person are you dropping that particular concern, or at least questioning it seriously? Or is there something else going on?
Is there evidence that it is substantially more risky than elective procedures that we let people pay doctors for?
IANAD, but one is inclined to suspect, perhaps wrongly, that removing a functioning organ is more risky than inserting a prosthesis under the skin, glands, or muscles.
I can’t say that I’m comfortable creating circumstances whereby people may feel they have no choice but to undergo major elective surgery. Even if the risks are no more drastic than that of elective cosmetic surgery (something I am nowhere near as comfortable taking for granted as you appear to be; five minutes of poking around found me a study citing 7-9 weeks of sick leave on average following donation), it still amounts to compelling people who will be disproportionately drawn from a particular social strata to gamble with their health for the benefit of people who would presumably be disproportionately drawn from a higher one.
This also ignores our current medical system; a market for kidneys that did not include sufficient regulation to ensure followup visits and care for donors would presumably see more complications from donors who couldn’t afford them on their own (or for that matter couldn’t afford to convalesce as long as they should).
“…but in general I would suggest that if it is in the same risk zone as an elective surgery like a breast implant surgery, that it doesn’t make sense to outlaw it on that basis either.”
Now, I don’t have stats on that, and I am, in fact, inclined to agree with you, but I do strongly suspect that there’s a greater iantrogenic risk than breast augmentation surgery, or most cosmetic surgery, on the grounds that when I had kidney surgery, it was a three day stay in the hospital with my kidney exposed externally, and a tube running into it, which I’m inclined to suspect makes one more exposed to both potential infection and serious problems than something that can be done on more minor organs or as an outpatient procedure.
But, I repeat, I’m just guessing on that, and I don’t disagree with your basic point; I’m simply suggesting that there may be some differences in types of surgery, as regards risk, worth considering in a serious discussion.
I’d, incidentally, just as soon never hear the term “renal colic” ever again. Nor have nurses consistently be inattentive enough to not empty out the bags that the tube from your kidney goes to so that they back up.
What, like taking a shitty job? Like living in a rat infested apartment? You’re not offended by “coercion”, you’re offended by “poverty”. You don’t have to subsume all the evils of the world under one word, you know.
Huh? Are you addressing me, Brett? I don’t recall discussing what does or does not offend me. I’m just saying that the situation people are arguing about doesn’t have to be a matter of coercion for it to be a problem, so let’s just discuss the problem, as in “what I think will happen is this,” and stop trying to decide if it is or is not a matter of coercion.
If you want to know, I’d say that both poverty and coercion offend me, at least in the sense that I don’t like them or think they’re good. Do you like those things?
As far as your argument goes, the fact that poor people suffer in (arguably) unavoidable ways doesn’t imply that they should also suffer in avoidable ways. If you want to argue that kidney sales will not result in undue or significant suffering for poor people, go right ahead.
But bringing up the fact that poverty sucks in a bunch of other ways doesn’t seem relevant, unless I’m somehow missing your point. Are you saying that, since being poor sucks, we shouldn’t worry about the negative effects of things on the poor, or what?
Alex, Seb, and Gary: you’re all right, I was way over line. I don’t know what I was thinking. Thanks for the gentle correction and my apologies again.
“And I’ve linked to the stats on iatrogenesis. So, So, as a science-respecting policy person are you dropping that particular concern, or at least questioning it seriously? Or is there something else going on?”
Umm, don’t I deal with this when I write “So the question shifts to short term issues. I don’t know exactly what the short term surgical complications risk is–but in general I would suggest that if it is in the same risk zone as an elective surgery like a breast implant surgery, that it doesn’t make sense to outlaw it on that basis either.”
You also write “But, I repeat, I’m just guessing on that, and I don’t disagree with your basic point; I’m simply suggesting that there may be some differences in types of surgery, as regards risk, worth considering in a serious discussion.”
Sigh. Well yes. Of course. But it has taken me days to get the discussion to the point where I don’t have to defend against the “taking the spare kidney=increased chance of kidney disease” question. And we’re still talking about coercion when none of the people talking about how important it is to avoid coercion have bothered to demonstrate that there is a more-serious-than-normal-for-ways-that-poor-people-get-money risk. Not to mention fending off accusations of not caring for the poor (unsupported by say any showing of special risk).
We wouldn’t have even gotten to the risk-of-surgery-itself question if I hadn’t done some minimal research and discovered that the alleged risk of increased kidney disease is apparently illusory (or at the very least much less significant than was assumed on this thread).
So yes, I’d love to talk about whether the risk of the surgery itself is a big enough deal to ban the sale of kidneys. It might be. It might not be.
The ebb and flow of the argument has essentially gone:
And note that I’m at least trying to engage pretty much everyone on the anti-kidney-sale side, while you are engaging about one or two (with a side digression with lj). So yes, by all means I’d LOVE to talk about the real issues if we can actually get there.
“So, what are they spending that ~$80,000 they got for the kidney on?”
Drugs and hookers! After all, if the poor didn’t make bad choices, they wouldn’t be poor, would they?
“I don’t know what I was thinking.”
I think it’s a pretty natural tendency for most of us, in our heads, to laugh and and make fun of our opponents if they make or hold what we consider to be silly arguments or beliefs.
Sometimes it’s easy to forget that we try to restrain ourselves in expressing such views here.
It’s so easy to hit “post” without pause, after all. We’d probably have a better internet if we had to crank a handle fifty times to get each comment to post. Someone should invent a rubber-band USB plug-in!
(Now if only John Emerson came by more frequently, he could pop up to denounce us all for the futile pointless harm such restraint does. If not, there’s usually someone to make the argument about the downside of civility. It prevents realistic appraisals! It’s a pretense that shouldn’t be engaged in! And it hurts my head to not fully express my Inner Child!)
“The ebb and flow of the argument has essentially gone….”
Well, that’s what comes of bothering to argue with a number of people with a variety of views, isn’t it?
I hear the Continental Congress took up a lot of time, too, and they had more motivation and more important issues to deal with.
I’m also reminded of 1776:
Some things never change. I’d suggest that internet discussions are among them, but in fact I’ve noticed the same problems with in-person discussions amongst people who are not all of like mind. And discussions in writing enable us to have a higher quality of discussion, if lengthier, by virtue of being better able to organize and present our thoughts, along with research and citations.
It allows those of us who bother to do so, anyway.
Anyway, going all meta probably isn’t helping. So let me recap:
If you are going to suggest that kidney sales should be banned because of exploitation worries about the poor, there are a couple of things we need to talk about.
Benefits: benefit to the person who gets the kidney is enormous. Financial benefit to the kidney donor is likely to be fairly noticeable.
Detriments: Long term–these apparently don’t exist or are essentially trivial. So that leaves short term risks.
I would challenge you to consider before we go further what you would consider to be an acceptable level of risk to allow kidneys to be sold.
I haven’t looked yet, but my moral intuition would suggest that if the risk of serious complications gets to say 3-5 times that of the fairly invasive elective surgeries I would strongly consider banning it.
This is why: we let people choose to pay for such surgeries and elect to take the risk. In the kidney case we are letting people get paid, so we sure surely allow at least the level of risk that people regularly are willing to pay for.
@CharlesWT:
So, what are they spending that ~$80,000 they got for the kidney on?
$80k? Shirley you jest. My readings over the last few days puts a 1st-world black market figure in the 30-50k range, with a global average down around 10-20k.
I obviously can’t say how much legalization would change the price, but I’d like to hear your reasoning for assuming a stable figure twice the black market figure.
Also, to hit the meat of the question, presumably they’d be using the money for whatever drove them to risk their health to get said money. Hopefully they’d factor in adequate post-operation health care and loss of income due to convalescence. But I’d feel a lot more comfortable with the whole idea if we had a more civilized health care system, and/or could reasonably ensure that market regulations would require comprehensive arrangements for such things to be included in every transaction. The donation carries with it health risks, both long and short. Claims that it doesn’t appear predicated on presumption of adequate care and convalescence coming out of the operation, and can’t be relied on absent that if accounts from oversea kidney sales where such things lacked are anything to judge by.
Well, that figure was off the top of my head. However, in an open market, prices might vary widely. A wealthy person with a difficult tissue match might pay a very high price whereas someone with a relative easy match would pay much less.
“$80k? Shirley you jest. My readings over the last few days puts a 1st-world black market figure in the 30-50k range, with a global average down around 10-20k.
I obviously can’t say how much legalization would change the price, but I’d like to hear your reasoning for assuming a stable figure twice the black market figure.”
That is counting shady middle men. End user purchases have been reported in the $150,000-$200,000 range (difficulty of getting accurate black market figures noted of course), so an in between $80,000 doesn’t sound crazy.
(And I’ll concede I came across as moreso incredulous than curious – I blame my whimsical inclusion of the aeronautic reference for skewing my tone in that direct. Apologies.)
“The CSM article cited upthread mentioned a cost-to-buyer at 140k for the case they looked at from the buyer’s prospective, and to my understanding that was including installation.”
On this at least I think you are wrong. The cost of putting in the kidney is far far above $140,000.
“Well… yes… but is that 150-200k for just the kidney, or is that parts and services? The CSM article cited upthread mentioned a cost-to-buyer at 140k for the case they looked at from the buyer’s prospective, and to my understanding that was including installation.”
Does it include a money-back guarantee?
What about coupons? Sales when you’re over-stocked! Two-for-the-price-of-one deals!
Buy now, pay later! No interest for the first two years!
Just thinking ahead a bit.
You might be able to get better terms on Craigslist than through a formal dealership.
[…]
Patterned after the stock exchange (or perhaps the commodity exchange is a more apt analog), I propose we create, as part of a market driven health reform initiative, a Kidney Exchange. Value maximization will ensure the free flow of kidneys into the most appropriate markets and the most appropriate recipients.
In the interest of fairness and transparency, full reports on each putative “donor” will be submitted to the exchange by medical clinicians who (as is the current practice among medical device researchers) will be paid in stock options in the subjects of their examinations. This stake in the endeavor will ensure commitment to the process. These reports will function as the basis for prospectus and, in the case of those not yet ready for immediate harvest, ongoing quarterly reports.
We would not, of course, limit the purchase of kidneys to those who “need” the actual kidneys, as that too would tend to skew the market. “Need” must be determined through the time-tested criteria of the market: availability of, and a willingness to use, investment capital.
[…]
A Kidney Exchange, less sentimental but more modern, would, of course, put the preference where the invisible hand of the market deems it best (though under Swift’s criteria the IMF, and World Bank would seem to be the sentimental favorites). In this way it would allow, as we do now with private health insurance, that most efficient of instruments, the market, to decide who lives or dies.
Kidney Sales, a Free-Market Approach
🙂
Something I haven’t seen addressed: for those who support the notion of a market in kidneys, what other body parts would you deem acceptable to sell? Lungs? Arms? Genitals? Hearts?
[The last might fall afoul of suicide laws, but let’s assume for the moment that such impediments to the market do not exist.]
In an ideal world with current medical technology, I imagine corneas would be the logical choice, though only after death, as it is the most common type of transplant.
Since there are people who are knowledgeable about the facts of kidney transplantation, I wonder if there is any benefit getting a young kidney versus one with some miles on it. The only anecdote I have is that my horn teacher donated a kidney to one of his best friends, and the combined ages of the donor and recipient were the highest for that transplant center, 145 years which can support Sebastian’s point about the relative safety of the procedure.
However, I still feel that the ick factor is so deeply rooted in our psyches that it is not really possible to have a full fledged market in human organs, so that it would have to be constituted in some way so as to shield the participants in some way.
It calls to mind a thread that Andrew participated in where someone was asking why the military holds recovering bodies as such a important task and Andrew was defending it. While logical arguments were made, at its heart, it is an irrational urge, quite possibly similar to the ick factor when we imagine someone taking a part of their body and giving it to someone else.
“But that’s something different, and is, essentially, the basis of all transactions.”
I think our pal Adam Smith would say that mutual benefit is the basis of all proper transactions.
This is one hell of a weird thread.
There is no freaking way in any conceivable world that a market in kidneys for sale won’t become exploitative.
Exploitation is, in fact, pretty widespread and, in practical terms, kind of unavoidable, but it’s also no justification for anything.
It’s certainly not the basis for any kind of society that any of us should want to live in.
When we get to the point (which, apparently, we may have achieved) that we accept selling irreplaceable body parts as a reasonable and legitimate way for people to address their own poverty, IMVHO we’ve crossed some kind of f*cked up moral Rubicon.
Blood, hair, sperm, eggs, all bad enough, but your body will make more.
Kidneys are kind of a different kettle of fish.
Isn’t that clear?
IF PEOPLE NEED TO SELL A KIDNEY TO GET BY, WE SHOULD JUST HELP THEM OUT.
My two cents.
IF PEOPLE NEED TO SELL A KIDNEY TO GET BY, WE SHOULD JUST HELP THEM OUT.
Without extracting our pound of flesh?
Something I haven’t seen addressed: for those who support the notion of a market in kidneys, what other body parts would you deem acceptable to sell? Lungs? Arms? Genitals? Hearts?
To be perhaps crotchety: I’d rather have a decision made just about kidney donation – or just about any particular thing. Rather than detouring as a contributory exploration into “what other things would you be okay with?” – because what good is that, here, except to have one’s other acceptances or rejections cast some sort of allegedly revealing light on one’s arguments on this specific matter – which I think would be of completely bogus value, if not just propagandistic value, compared to the value of one’s specific arguments about this matter?
This is the great entropic trap with all this: we are obliged often to refer to general questions in order to analyze specific matters, but people – especially we people prone to come here and do this – are particularly addicted to going off and judging according to generalities, to the point where sloppiness about the specific applications is so distant as to be invisible. “There, you see, Bart is an Erratic Ponticrabist on general sales and a Ponticrabist just in general! And he’d be okay with X different situation! What to think of his take is clear.”
Yes, what to think of other transplant matters is interesting and may be valuable, but I suggest we finish with the matter of kidney sales first, because it’s a dangerous distraction – unless there’s first some airtight reason why kidney sales can’t be weighed on their own, or why answers about other organ sales really might retwiddle the best answer here.
So, what if someone just wants to buy that sports car they’ve always wanted?
russell, “exploitativeness” has been discussed from enough angles in fair depth in this thread that you should go into more depth about it before making it a premise. What is its shape?
It isn’t just poor people who might want to sell a kidney. I might want to, at those predicted prices – well, actually I might qualify as poor, but Sebastian also says he might at those prices, and I don’t know, but I think he’s doing a fair bit better than me. If Sebastian is indeed doing however quite well, and he decides to sell a kidney for the financial reason, is the thing therefore for us to help Sebastian out? There are a lot of upper-middle-class people or better who could use us, then.
Actually, it might not be the desperate poorest people who are selling the kidneys at all, even. Such people aren’t as well hooked up to information as people who have more resources. They might not get to it. It would be more likely to be any given person who wants a car or a down payment on a house. The poorest might miss out. That has been bugging me the whole time about, for example, Kevin Drum’s horrified framing of a poverty-stricken family facing Snidely Whiplash standing at the door with a wad of bills in his hand. Why would it be them?
Unless the background assumption is that it would have to be them because only the most desperate would do something “so abhorrent.” Which seems unlikely.
But the abhorrence seems to be central to your reaction. (It’s possible that you might be folding riskiness in there, too… althought Sebastian has done a lot of research-citing about the implications, or lack of same, of having only one kidney, which seems to take it down to the basic short-term risk of having major surgery.) I’ll just say that reliance on basic abhorrence of something, or reliance on its repugnance, in my experience, has usually led to conclusions that I have strongly disagreed with – that are usually imposed without consent on people other than those who are doing the abhorring and seeing the repugnance.
(I was surprised to see you write: “Blood, hair, sperm, eggs, all bad enough…” Bad enough? Those things? Intrinsically, I take it? I have sold plasma for years. It has been a source of extra cash, that has sometimes been very valuable in tight spots. Does this offend you? Do you want to stop me from doing it? Please answer.)
The foregoing would also include my reaction/response to liberal japonicus’ point: It’s possible that you might be descriptively right about the ick factor in society and its level of influence, but I think I have made clear my view about deference to the ick factor, and my view of its level of contribution to the best answers.
Sebastian was generous about it a ways back (I can’t find it now), saying that he saw a value in society attending to such impulses here and there. I am not sure why. I don’t. In any case, we do agree on whether it should be a deciding consideration in this question.
“[The last might fall afoul of suicide laws, but let’s assume for the moment that such impediments to the market do not exist.]”
They just need to keep working on these.
Also, cloning body parts.
Also, I hear of a certain Wizard, in a place whose name begins with “O.”
“Genitals?”
I already get a lot of spam, and see late-night tv ads, that seem to come close to such offers.
“So, what if someone just wants to buy that sports car they’ve always wanted?”
Ever seen Leaving Los Vegas?
Or even Leaving Las Vegas?
Actually, it might not be the desperate poorest people who are selling the kidneys at all, even. Such people aren’t as well hooked up to information as people who have more resources. They might not get to it. It would be more likely to be any given person who wants a car or a down payment on a house. The poorest might miss out.
I hadn’t really considered this before, but it does ring somewhat true. I would imaging there would be some amount of bureaucracy to navigate in forms to fill out, places to go for prerequisite testing, records to manage, etc. that most of the poorest among us and some significant segment of the merely not-so-well-off would lack the resources to get through. I don’t imagine one would simply show up at the ER, have a kindey removed and walk off a few days later with a check. I think this is a point worth considering.
“But the abhorrence seems to be central to your reaction.”
You got that right.
“I’ll just say that reliance on basic abhorrence of something, or reliance on its repugnance, in my experience, has usually led to conclusions that I have strongly disagreed with “
Then we’re likely to disagree on this topic.
“I have sold plasma for years.”
I know a number of folks who’ve sold plasma. IMO it’d be better if folks didn’t have to sell their blood products to make ends meet, but there are worse things to do.
“Does this offend you?”
No, not really.
“Do you want to stop me from doing it?”
Nope.
Why are kidneys different?
It’s major surgery, period. There is no risk-free major surgery.
It’s not a body part that your body will remanufacture.
You aren’t donating into commodity bank, like you do with plasma or sperm, you’re generally donating to a specific recipient, which lends itself to folks with a lot of money getting preferred access to other people’s body parts.
You know, if you want to sell a kidney for a sports car, I personally find that kind of f*cked up, but I’m not sure you should be prevented from doing so.
I have a bigger problem with people selling body parts to survive, because then you are definitely into exploitation-land.
But basically, IMVHO the whole shooting match — selling parts and products of your living body for money, for whatever reason — seems profoundly screwed up to me. And for the record, the “screwed up” part here is the fact that people find themselves in the position where selling pieces of themselves is their best available choice.
Nobody should have to find themselves in that position.
If you feel like a sports car is more valuable to you than a piece of your body, I find that profoundly weird, and I might suggest counseling, but that’s your problem.
I don’t really feel that way about hair, which is basically dead tissue that you don’t need for any particular reason, and that we regularly cut off anyway. If you could find a market for fingernails or toe clippings, same deal.
Blood, sperm, eggs, other parts for sale just seems profoundly problematic to me, on its face.
Just my two cents.
“lack the resources to get through”
The mortgage industry managed to solve that problem with no money down, no proof of income, signature loans…of course it was provided at a premium. I am sure that there will be some enterprising entrepreneurs finding ways to separate the poor from their kidneys while keeping the finder’s fee.
“But basically, IMVHO the whole shooting match — selling parts and products of your living body for money, for whatever reason — seems profoundly screwed up to me. And for the record, the “screwed up” part here is the fact that people find themselves in the position where selling pieces of themselves is their best available choice.
”
Is it their best available choice, or is it the fastest and “easiest” choice? If you can work two years to earn $50,000, or under go surgery and 2 weeks of recovery for $50,000, which is the best available choice?
I agree that it can be exploitative, but I am not sure that equates to being the “best” available choice, as opposed to the seemingly easiest.
The mortgage industry managed to solve that problem with no money down, no proof of income, signature loans…of course it was provided at a premium. I am sure that there will be some enterprising entrepreneurs finding ways to separate the poor from their kidneys while keeping the finder’s fee.
I had similar thoughts after posting my comment. I think it would depend on the controls in place and how much could be done by proxy. And the mortage industry didn’t do much targeting of the poor, just people who couldn’t necessarily afford what they were buying. I think the people under consideration haven’t been homeowners in large numbers.
So, what’s up this weekend, jrudkis?
“If you can work two years to earn $50,000, or under go surgery and 2 weeks of recovery for $50,000, which is the best available choice?”
If you’re asking me, I’d say work two years.
But, whatever floats your boat.
Look, the discussion here seems to assume that “low risk” major surgery equates to “piece of cake”. Any major surgery invites risk. Any decent doctor will advise you away from unnecessary major surgery.
If you want to undertake that risk to help out another person, due to family connection or plain old altruism, I applaud you.
If you want to take it on to buy a BMW, I’d say your priorities are f**ked.
If you find yourself in a position of undergoing major surgery and removal of a vital organ because it is, frex, the only way to keep from losing your house, I’d say we’re all f**ked.
People shouldn’t have to sell pieces of themselves to get by. It’s kind of hard and maybe pointless for me to push this particular argument forward, because you’re either on board with the idea or not. If it occurs to you to wonder if maybe it’s not so bad for people to sell their bodies off by the pound to get stuff they want, there’s probably nothing in particular that I’m going to say that’s going to make much difference to you, and after this post I’ll drop it.
But trust me, it’s f**ked. The only reason there’s even a question is that we live in a brutal, mercenary, dehumanizing, pathological culture.
And it’s kind of cute to talk about, but I doubt anyone here is seriously going to sign up to have their kidney removed so they can buy a car. The folks who are going to do that are folks who are up against it financially.
That means rich folks get to buy poor folks’ organs. Trust me, that is f**ked.
As always, my two cents.
Want to come by my parents house with the brood Friday night (or Saturday)?
Sure. Send me an e-mail, so we can nail down details without abusing ObWi privileges any further.
russell, you’re a persuasive guy. You write like a cold shower on a groggy morning.
“You aren’t donating into commodity bank, like you do with plasma or sperm, you’re generally donating to a specific recipient, which lends itself to folks with a lot of money getting preferred access to other people’s body parts.”
This is not, in fact, how UNOS works.
They also have a pilot program for people who want to donate to a specific person, but who aren’t compatible, where such people are paired up with another donor.
Stats on donation by donor relation. Pull down “Living Donor Transplants By Donor Relation” and “kidney.”
Most donors are related by blood, due to compatibility issues. Then there are spouses and life partners. Then there are “Non-Biol,unrel: Paired Exchange.” I think that translates to “friends.” Then there are “Non-Biol,unrel: Anonymous Donations.” Then there are “Non-Biological, Other Unrelated Directed.”
I don’t want to list all the figures — you can read the chart for yourself — but the latter category lists 13,228 donors to date out of a total of 95,136 for “all donor relations.”
So, in fact, while there are many directed donations, plenty are also like “donating into commodity bank, like you do with plasma or sperm.”
I take it you’ve never watched ER. 🙂
I wouldn’t take that risk for a thing, like a car, but I might take it to make sure my kids can get out of college without debt: I would be donating to my kids despite the fact that the kidney is going to some rich guy.
I also might take the risk to donate a kidney so I will be higher on the list for the inevitable liver I am likely to need.
russell: The sports car wouldn’t be my own idea. I don’t even drive. :o) But otherwise… if you think that, trust you, no one but those really up against it financial are going to want a lump sum of $50,000-$100,000, you must truly be horrified by this.
As to the rest:
You say simply “You got that right” about abhorrence or repugnance, and say of my comments about it that we are likely to disagree then. For what it’s worth, I’ll try explaining why I would be horrified to find myself giving similar assent and trust to my own repugnance or lack of it:
Opposition to gays and to gay rights has largely been based on exactly that, to assuming that one’s own visceral reactions are reliable about how other people should be and how other people should feel.
From my sense of you, I’ll guess that you’d support gays and gay rights. If you do, but you give this total assent to the place of visceral reactions, what can I think but that you are extending your LACK of a visceral reaction to say how other people should be and feel. While finding the gut-reactions you do have meaningful when you do have them. Your gut rules justice either way.
And, around us, other people are doing the same thing, on all sorts of things – to the tune of much heedless injustice, which is exactly what own-gut-dominance lends itself to.
I have no way of arguing with an authoritative disgust-reaction, but I can say a few things:
My own support for gays and gay rights, and for some other things as well, has come from the idea that what what I find repugnant, or not repugnant, is my business and must be treated as such, and what other people find repugnant, or not repugnant, is their business and must be treated as such, and that breaches of this general rule amount to unjust and destructive impositions.
I also think that, if I am going to help anyone, that I should not help them in my opinion at the expense of their opinion, unless I am going to stop calling what I am doing to them helping.
One thing you should note on this question: When you make the frame “I have a bigger problem with people selling body parts to survive, because then you are definitely into exploitation-land”… note that, in the case you just mention, they were doing it to survive – and you are taking that option away.
I agree with a second bit: “And for the record, the “screwed up” part here is the fact that people find themselves in the position where selling pieces of themselves is their best available choice. Nobody should have to find themselves in that position.” And in the next post you say, “If you find yourself in a position of undergoing major surgery and removal of a vital organ because it is, frex, the only way to keep from losing your house, I’d say we’re all f**ked.” Poverty and tight-corner circumstances are the screwed-up part here, the coercive part. You’re angry at that. Address that! Definitely, absolutely do. Gary mentioned supporting a negative income tax option, or do it however you choose. Reduce the tight corners. But to stop someone from rescuing themselves in the meantime because you find the way icky and inhuman, because it’s “f**ked” and “no one should have to”? What happens then? To them? (And don’t say that that’s not your problem when your idea is to intervene.)
On the other hand, if you were really just on “whatever floats your boat,” we’d have no disagreement.
In the meantime, yes, poverty, and sparseness of options, is what’s f**ked.
“Blood, sperm, eggs, other parts for sale just seems profoundly problematic to me, on its face.
Just my two cents.”
Egg donorship involves minor surgery, so that seems to me a bit different than donating blood, which although needles squick some people profoundly, still seems trivial to me. And sperm donation doesn’t typically, according to majority practice, as I understand it, involve pain.
I’m really not clear what you find problematic about these things.
I do think there’s obvious a scale — of which our own personal scales vary — of things we find problematic for one reason or another, and I certainly agree with you that there are things people shouldn’t have to do in order to economically survive and provide for basic needs, including organ donation, and prostitution.
On the other hand, we can include on the scale, but distinctly upwards on it, having to take a really sh*tty job, instead of a more preferable one. Or having to only afford a really crap place to live, as opposed to a slightly nicer one. Etc.
So it does seem to me — and I’m doubtless stating the banally obvious here — that what’s problematic isn’t a binary thing so much as a scalar thing. Or maybe choices can be divided into those two categories, with the latter then being subdividable.
But my own opinion is that the essential problem is society not providing certain minimal necessities of life for everyone who can’t provide for themselves. Specifically: shelter, minimal food, and medical care, if people are unable to provide for themselves.
Once those are taken care of, I’m inclined to let people make what arrangements they want, as innumerable exchanges in a capitalistic system are classifiable, to one degree or another, as “exploitive,” and I don’t see any sort of universally agreed-upon objective scale for that.
Alex –
I see where you’re coming from with the repugnance issue.
The thing I find repugnant is not surgery, or the “icky” aspect of it. I have, in fact, been an organ donor myself, albeit at a very, very low risk level (bone marrow, for a family member).
What I find repugnant is the idea that people will be placed in the position of selling off their own damned vital organs in order to secure their basic needs.
And to further clarify, I don’t find those people personally repugnant, what I find repugnant, or abhorrent, or what have you, is a cultural climate in which selling your vital organs is seen as simply another species of commercial transaction.
I got something you want (a kidney), you got something I want (money), let’s deal.
To me, personally, that seems brutal and mercenary. Obscenely so.
It’s like we’ve replaced “Are there no workhouses?” with “Don’t you have a spare organ or two?”
In short, the fact that we’re discussing a commercial market in personal bodily organs should be a great, big, fat red flag to all of us that something has gone awry.
We really, really should be able to find better ways to help and care for each other.
I take your point that “I think that’s icky” is not a useful or sufficient basis for objecting to things that other people want or need to do. I hope my explanation here makes my meaning more clear.
Gary, thanks for the information about the organ banks.
But to stop someone from rescuing themselves in the meantime because you find the way icky and inhuman, because it’s “f**ked” and “no one should have to”? What happens then? To them?
I think russell clarified the “icky” thing. That aside, don’t we stop people from “rescuing” themselves all the time? I think the point is that the short-term rescue is, in the long run, worse than what someone may be trying to save themselves from. In any given case, we can argue about the means of rescue versus the immediate peril, which is fine. But to suggest that people shouldn’t be stopped from doing whatever they might think it takes to get through a financial or other hardship doesn’t seem consistent with being civilized. This line of thinking would justify all manner of exploitation, unless I’m missing something.
Any of you fellas want to touch this rebuttal?
“I think the point is that the short-term rescue is, in the long run, worse than what someone may be trying to save themselves from. In any given case, we can argue about the means of rescue versus the immediate peril, which is fine.”
Ok, but again the long term risks appear to be vanishingly small to non existant. So you aren’t trying to save them from an in-the-long-run.
Is anyone else willing to precommit to the level of immediate surgical risk that would make it ok?
Ok, but again the long term risks appear to be vanishingly small to non existant. So you aren’t trying to save them from an in-the-long-run.
That’s disputable, but I’m not necessarily trying to dispute it. Again, I’m just trying to clarify what the argument is. Simply saying that we shouldn’t be keeping people from rescuing themselves as a general statement fails if the rescue is worse than the peril (and given the many uncontroversial restrictions of this general nature that have been placed on individuals by law for some time).
hairshirthedonist: Saying that Sebastian’s comment about long term risks is disputable is – well, can you find evidence that contradicts the citations he’s found suggesting that long-term risks are very low? (We can call anything in here “disputable” if we still wish to dispute it. It’s too loose. The research might show that it is hard to dispute.)
But you were trying to clarify the general argument, in any case. Two questions about your comment, that sort of interrelate:
1. Well, what counts as “the rescue is worse than the peril”? Surely Sebastian’s comments about long-term and short-term risks would be relevant to the judgment about selling a kidney. Why would selling a kidney be worse than the financial need, if it were worse? (One thing I would not want, or could not follow you in, is if “worse than the peril” remained unspecified, or in any sense, including anyone’s unspecified sense that it ought to be worse.)
2. (might be a way to answer #1): There is a lot of specific kinds of “worse” or reasons for “worse”. So, specific cases that you think fit this: Which kinds of “rescue worse than the peril” situations, presently restricted by law or not, would you compare selling one kidney to? Which kinds of such situations would you not compare it to? (Not all of them would be uncontroversial, necessarily.)
Left general, the general statement that “some rescues are worse than the peril”, or that some options are banned for that reason, may be true but is not yet useful. (I didn’t even include the question, “in whose opinion.”)
Sebastian: I like the focus on making personal risk cutoffs explicit. But embarrassingly I cannot follow you as far as a number. Because, thinking about it, I could come up with a risk that would be too much for me – but I cannot come up with a risk that would be the right answer for an unspecified person different from me. Other people are more (or much more) or less (or much less) willing to take risks than I am. Any answer I came up with – that would be intended to be authoritative as far as I am concerned! it would be intended to control when to ban something for everyone – might as well have come out of a Ouija board. And I don’t have any faith in Ouija boards.
The one thing I can say with certainty is that I do accept that people can take risks if they judge those risk worth it. So, the closest I can get to an answer is not about the level of riskiness. It is an insistence that, if doctors or people involved misrepresented the riskiness to a prospect for the operation, or failed to adequately advise the prospect of the risks, they would be laying themself open to massive civil liability. (… Which would probably be the case already.)
“Any of you fellas want to touch this rebuttal?”
Sure.
Distributed republic is quite right. Wal-mart is not actually going around and deliberately impoverishing people in order to coerce them into selling their fingers.
Noted.
It’s just a crappy world when people have to sell their bodily organs to get by.
You don’t think so? I’ll give you $500 right now for the last two joints of your left pinky. What the hell do you need your left pinky for?
$500 ain’t nothing, dude. I’ll wire you the $$$ via PayPal, you’ll have the money in about one New York minute.
Do we have a deal?
The topic of the thread is “why kidney selling bothers me”. My answer has nothing to do with macoeconomics, libertarian purism, or any of that crap.
The reason it bothers me is that it’s a sh*tty world when people have to sell off parts of their own bodies to get by.
And there’s no freaking reason why the world has to be that sh*tty.
We spend just short of $20B a year on pet food in this damned country, and people should have to sell their own kidneys to make their way?
How f**ked up is that? Seriously, how f**ked up is that? Have we all gone out of our freaking minds?
Consider the rebuttal touched.
Over to you.
“Any of you fellas want to touch this rebuttal?”
A couple of bits: “But Wal-Mart doesn’t make people poor*.”
No, they don’t, and obviously they don’t make their employees poor: they make them wealthier than they would be without their voluntarily sought after and taken jobs.
But Wal-Mart does do its best to break and keep out unions, which they’ve done quite successfully in this country, and if they didn’t make that choice, their employees would be less poor. Neither is this a case of having to do it; see a comparison between the choices Wal-Mart makes in employee treatment and benefits, and what Costco does.
So, no, I certainly wouldn’t characterize Wal-Mart as using force, but I would characterize them as being less beneficial corporate citizens to their employees than they could be, and in my opinion, should be.
That’s certainly not the consensus the discussion overall has come up with.
Now, that’s something we have a consensus upon. But let’s conveniently ignore what the discussion has actually produced, and liberals actually think, in favor of denouncing straw liberals, shall we?
And it saves so much reading time to just ignore what people have written.
But, wait, you say, Brandon Berg is only responding to publius’ post, and not to the rest of the discussion!
Except, fail, because what publius actually wrote was:
So let’s ignore publius, too, in favor of made-up straw liberals. They’re so much easier to argue with. So much for “a fairly solid rebuttal” to any of the actual discussion here, or to what publius wrote.
“Saying that Sebastian’s comment about long term risks is disputable is – well, can you find evidence that contradicts the citations he’s found suggesting that long-term risks are very low?”
I’m a little tired of posting links about iatrogenetic risks, and the numbers, myself.
“And I don’t have any faith in Ouija boards.”
That’s only because you haven’t consulted one to ask about how much faith you should place in one.
Russell:
If you make it $5000, I’ll start thinking seriously. Though I doubt I’d let it go for less than $10k, and I’d definitely start with a much higher offer, and haggle down, and see where we end up.
My opener is that for $100k, we absolutely have a deal. And I’m rather fond of my pinky, even though I don’t even have a ring for it.
I suppose I’d just have to find another way to pick my nose. Or pick my toes in Poughkeepsie.
“Saying that Sebastian’s comment about long term risks is disputable is – well, can you find evidence that contradicts the citations he’s found suggesting that long-term risks are very low?”
I’m a little tired of posting links about iatrogenetic risks, and the numbers, myself.
Gary – You have indeed been posting links about iatrogenic risks. Those I classed, and I think Sebastian has too, as short-term risks. Sebastian has posted research about long-term risks of having only one kidney. That’s what I was talking about, and what I presume hairshirthedonist meant by long-term risks.
“I’m a little tired of posting links about iatrogenetic risks, and the numbers, myself.”
We’ve been trying to talk about the short term risks but no one else on the anti-kidney-sale side seems interested in engaging, and all you are doing is linking, so what would you like?
(Reckon I’ll take a break. I’m starting to have loopy thoughts about whether I get to eat anyone’s liver yet.)
with fava beans and a nice chianti? 🙂
…what I presume hairshirthedonist meant by long-term risks.
I considered a follow-up to eliminate the short-term/long-term distinction. It really doesn’t matter. What does is “which is worse overall?”
And to follow up, Alex Russell, on your August 05, 2009 at 04:43 PM comment, what I was responding to was what I took to be your application of a general principle illustrated by:
But to stop someone from rescuing themselves in the meantime because you find the way icky and inhuman, because it’s “f**ked” and “no one should have to”? What happens then? To them?
But now I think you were writing specifically about the case at hand (kidney sales) and simply doing so in general terms, not applying a general principle to the specific case of kidney sales. So I don’t disagree with too much of your response, at least not enough that I want to bother getting into detail about it.
I’m more ambivalent about this issue than I was when this thread started, and most of my later comments regard the nature of the arguments being made rather than trying to make an argument in favor of a particular conclusion. It seems I’ve gotten a few resposes to my comments as though they were otherwise.
Incidentally, russell seems to have moved to another mode of discussing this issue that regards a larger concern for where we are as a society or perhaps as a species. I don’t know what that says about a ban on kidney sales, since it would seem to be a Titanic-meets-deck chairs scenario, if I’m understanding him correctly.
“Gary – You have indeed been posting links about iatrogenic risks. Those I classed, and I think Sebastian has too, as short-term risks”
Okay. Myself, I figure that when:
I figured that being dead counts as a pretty longterm risk, but I’m not going to quibble about categories here, so long as we’ve acknowledged the factor.]
And as a reminder to anyone who hasn’t religiously read this entire thread, I’m not opposed to sales of kidneys, though I do lean more towards favoring a third party intercessor than towards direct sales; but mostly since I’m not forced to have an opinion, I don’t have a strong opinion, and I definitely haven’t come out against allowing either kind of sales/compensation, myself.
I merely thought that Sebastian was tending to brush by iatrogenetic factors when he keeps referring to the “low risk”involved.
I have nothing else to add or argue for now. Amazing, isn’t that? 🙂
Russell, I enjoy some nice chicken livers with onions, well salted and peppered, on occasion, myself. With or without chianti.
The greatest long-term risk to having a single kidney is suffering an injury that damages or destroys the kidney, but would have left the other kidney intact if you still had it. The upside to having a single kidney is that you might have to suffer through passing only half as many kidney stones.
I figured that being dead counts as a pretty longterm risk, but I’m not going to quibble about categories here, so long as we’ve acknowledged the factor.
I see. One of those miscommunications. Like having talk of a high risk in die-rolling turn out to be referring to the “6” being a high number.
If I may, then – suggested use: “Short-term” risk” here refers to risk of bad outcomes in the short term upon/after surgery, while “long-term” risk refers to the risk of bad effects years or decades later.
I suggest that “risk” refers to possibility/probability/chance of a bad outcome, rather than to a bad outcome itself.
A possible outcome of death, though death does last forever, is not therefore what is meant by “long-term risk.”
At any rate, that is how I have been using vocabulary, and I believe Sebastian too. This may eliminate a (frustratingly mystifying up to now) logjam, maybe. So, now that it’s clear we haven’t been ignoring the information on iatrogenic risk/surgical error…?
“The upside to having a single kidney is that you might have to suffer through passing only half as many kidney stones.”
Or undergo extracorporeal shock wave lithotripsy, which I can testify is no real big deal, aside from the novelty for men of dealing with the epidural, which is mostly just strange, rather than, in my experience,particularly unpleasant.
On the other hand, if you have to undergo invasive surgery to deal with your kidney stone, because it’s too large and tough to be dealt with by extracorporeal lithotripsy, I can also testify that that’s not so much fun.
So you can have six of one, or probably less than half a dozen of the other, but don’t ask me which is which.
Oh, but also relevant if you have a kidney stone too large to pass, is having a renal stent inserted (fortunately, under general anesthesia); if you don’t know what that is, or how it’s done, don’t ask, but I’m willing to assert that it’s very very unpleasant to just live with. Especially if your kidney surgery gets repeatedly postponed for various reasons, such as overly high blood pressure, and being bumped by higher-level emergency surgery, and so forth.
Though you can get a nice supply of pain pills out of it, fwiw.
“If I may, then – suggested use: ‘Short-term” risk’ here refers to risk of bad outcomes in the short term upon/after surgery, while ‘long-term’ risk refers to the risk of bad effects years or decades later.”
Fair enough.
I’d still note that iatrogenetic effects can include effects that don’t manifest for many years, such as higher antibiotic resistance — there are plenty of other iatrogenetic effects besides death — but I do take your point, and won’t quibble further about the usage of “risk.”
Saying that Sebastian’s comment about long term risks is disputable is – well, can you find evidence that contradicts the citations he’s found suggesting that long-term risks are very low?
The assorted links posted by others upthread suggest that, absent proper medical care and/or a decent standard of living following donation, there are very real long-term risks in terms of decreased quality of life and health. Given that you specifically follow up the above comment with discussion of would-be donors being faced with a choice of kidney sale or grim financial need, I’m far from willing to take for granted that we should assume adequate health care (and convalescence) would be available to all paid donors. Barring assumptions to that effect, I’m really not sure why we should take a study suggesting no long-term ill effects from having a kidney extracted* from voluntary donors as being conclusive evidence that there are no long-term risks for paid donors.
*One interesting bit of trivia I stumbled across is that around one in 750 people, predominately males, are born with only one kidney. Excepting the fact that single-kidney failure would require transplant or suchlike, they’re supposedly no worse off healthwise than renal redundants. This adds weight to the suggestion that long term risks would most likely arise from the surgery and aftercare, not from having only one kidney.
I think it would be clearer to discuss risks arising from having only one kidney vs. risks arising from having a kidney surgically extracted instead of the vague usage we’ve seen here with “long term vs. short term”. FWIW.
No fellas – this argument by Brandon in particular:
“If the poor are to remain at their current standard of living, they’re made better off by being given the option to sell their kidneys. If we do find some way to mitigate poverty further than we already have, the poor are still made better off by being given that option. And it’s very unlikely that legalizing kidney sales will prevent further attempts at poverty mitigation.”
It would be nice to read some argument beyond “it’s a sh*tty world when people have to sell off parts of their own bodies to get by.” Any argument that would make someone see how the poor are worse off by giving them more options rather than less?
The assorted links posted by others upthread suggest that, absent proper medical care and/or a decent standard of living following donation, there are very real long-term risks in terms of decreased quality of life and health.
Which “assorted” links are you referring to that make this particular point? It’s been a very long thread. :o)
Given that you specifically follow up the above comment with discussion of would-be donors being faced with a choice of kidney sale or grim financial need, I’m far from willing to take for granted that we should assume adequate health care (and convalescence) would be available to all paid donors.
Well, depending on where you look otherwise, I’ve also suggested that a lot of people, maybe most people, who did this would not be facing grim financial need at all. And I think I’ve also mentioned that I support universal health care, a single payer system or basic health care safety-net in one form or another. Regardless, the case of a very poor seller is certainly part of the picture – and, regardless of whether we specially focus on this case or not, I could see requirements that adequate convalescence arrangements be part of the deal. Certainly such lousy arrangements as you mention are possible. The question then is, therefore… what? The question of how you weigh the question of these risks is still there.
I think it would be clearer to discuss risks arising from having only one kidney vs. risks arising from having a kidney surgically extracted instead of the vague usage we’ve seen here with “long term vs. short term”. FWIW.
Fair enough. Less brief, but it seems it might have saved some trouble.
“If the poor are to remain at their current standard of living, they’re made better off by being given the option to sell their kidneys. If we do find some way to mitigate poverty further than we already have, the poor are still made better off by being given that option. And it’s very unlikely that legalizing kidney sales will prevent further attempts at poverty mitigation.”
Much of the discussion here is about the ways poor people (or anyone else, possibly) would not be better off with that option. You might disagree with that discussion, but it’s certainly there. Read some more. It shouldn’t be hard to find. The reason the poor in particular are mentioned is that poor people would be far more likely to make the decision to sell their kidneys out of desperation and, therefore, in an ill-advised manner. For some, it would probably work out just fine. For others, not. But it’s a lot easier to exploit desperate poor people by waving money at them than others. Maybe you’re cool with that, and maybe you aren’t. Finding new ways to make poverty suck might not be high on people’s lists of things to do.
It would be nice to read some argument beyond “it’s a sh*tty world when people have to sell off parts of their own bodies to get by.” Any argument that would make someone see how the poor are worse off by giving them more options rather than less?
Mostly, see above. Otherwise, the “it’s a sh*tty world” thing doesn’t necessarily have to apply just to the poor, btw. It can also be a statement about people of any stripe selling their organs for money, if that makes any difference. Some people just think the whole deal is perverse.
I’ve pretty much given up on making arguments on the subject, so I’m just pointing out what kind of arguments are being made, since you seem to be looking for them, mr. pencil.
“No fellas […]”
“It would be nice to read some argument beyond ‘it’s a sh*tty world when people have to sell off parts of their own bodies to get by.’ Any argument that would make someone see how the poor are worse off by giving them more options rather than less?”
No, yourself, fella: first, you answer this question, please: have you bothered to read all the previous comments in this thread?
If so, your question has been answered. And you know that.
If not, why are you asking a question when you haven’t bothered to read the many many answers? Why is Brandon refuting claims not made in the post he’s allegedly responding to? Why is Brandon “refuting” a discussion he clearly hasn’t bothered to read?
We’ve already gone first, second, third, and a few hundred times more. Your turn, now.
“it would seem to be a Titanic-meets-deck chairs scenario, if I’m understanding him correctly.”
You read me aright.
“It would be nice to read some argument beyond “it’s a sh*tty world when people have to sell off parts of their own bodies to get by.” Any argument that would make someone see how the poor are worse off by giving them more options rather than less?”
Let’s bring back indentured servitude. Screw that, let’s let people sell themselves into chattel slavery.
Why stop at a kidney, let me buy your whole damned ass.
Why not?
You tell me why the poor are better off by having the option of selling themselves into slavery denied to them.
Who are we to deny them that choice? It’s their life, isn’t it?
Go ahead and riddle me that, and I’ll be happy to continue a discussion of whether folks selling their vital organs is a splendid idea or not.
And for the record, at no point whatsoever have I said that selling organs should be outlawed. The original question on the table is “Why kidney selling bothers me”.
I think I’ve made my answer to that question clear.
I wonder if after a couple of decades of folks selling their kidneys on the open market, we would have a whole lot of less-well-off people with one kidney and a whole bunch of bond traders, highly paid atheletes, celebrities, and John Boehner with three kidneys.
I think it’s more likely we’d see a John Kidney with three boehners.
Ba-da-dum-da!
Gary’s joke makes me wonder what is the difference between arguing that poor people should be able to sell their kidneys and that prostitution should be legalized? Is it that getting dialysis is a lot worse than not getting sex?
LJ,
I think more people would support legal prostitution than legal body part shops. Though I could be wrong. Maybe that is because the oldest tradition is clearly here to stay, while true human meat markets are pretty new.
I start from a position that assumes prohibition creates black markets, massive price increases, and then crime to pay for the product…followed by organized crime to victimize everyone.
I think the difference is scale: Kidney transplants will never be as lucrative as prostitution. Prostitution is therefore more of a threat of creating a destablizing black market.
So,, If I had to choose, I would legalize prostitution before legalizing kidney markets. Black market sex causes more problems than black market organs.
Thanks, and I should have laid out my thoughts rather than just toss that out there. My own feeling is that both are powerful opportunities for exploitation, which makes them both problematic. I understand that the way prostitution is controlled often criminalizes precisely the person who is being exploited, but making the sale of kidneys illegal does precisely the same thing. I would be hesitant to accept an argument that because women are more likely to have problems with poverty, they should be allowed to sell their bodies, and that seems like a mirror of the argument that the poor should be given a chance to profit from their kidneys.
A look-the-other-way attitude at some U.S. hospitals may be fostering a black-market trade in kidneys, transplant experts say.
Some hospitals do not inquire very deeply into the source of the organs they transplant because such operations can be highly lucrative, according to some insiders. A single operation can bring in tens of thousands of dollars for a hospital and its doctors.
Despite guidelines from various groups and Medicare, U.S. transplant centers are mostly free to write their own rules for screening donors to make sure they aren’t selling their organs. The questions they ask vary widely. Some hospitals require long waiting periods to weed out shady donors; others don’t.
“Some have a pretty cursory examination, like, ‘Are you sure you want to do this?’ ” said Art Caplan, a University of Pennsylvania medical ethicist involved in a U.N. task force on international organ trafficking. “Some don’t look very hard.”
[…]
Lax hospitals may be fostering kidney-selling
I said it already on page 1: An important question about both prostitution and selling of body parts is, whether the right to do it can be construed as an obligation in certain circumstances including poverty. And as I have said, there was an actual debate in the German parliament, whether unemployment offices could offer women jobs at brothels (including as prostitutes, not just as waitresses etc.) and cut unemployment benfits in case of refusal*. The letter of the law would have allowed that. In a more narrow reading it would even have mandated it. The implementaion rules had to be amended to prevent that. If body parts could be qualified as ‘assets’ then the same could apply there. Thus it is not a merely academic question.
*Prostitution became officially legal at about the same time that the unemployment benefit rules were tightened.
Let’s bring back indentured servitude. Screw that, let’s let people sell themselves into chattel slavery. Why stop at a kidney, let me buy your whole damned ass.
1. This sort of behavior certainly sounds abhorrent. Still, on what ethical basis would any of us feel justified in legally restricting two consenting adults from entering into a contract with one another? You’ve said yourself that “at no point whatsoever have I said that selling organs should be outlawed”. What of this?
2. I’m not sure this option is as far removed from the mainstream as you think. When you enlist in the military you do their bidding within the rules of their law; which does include severe penalties for going AWOL, desertion or insubordination to a superior. This is not so structurally different than entering into a servitude contract where similar infringements on your liberties are also agreed upon by both parties in advance.
And for the record, at no point whatsoever have I said that selling organs should be outlawed. The original question on the table is “Why kidney selling bothers me”
At the head of this entry I read:
The real challenge then, as John Schwenkler notes, is to justify the ban on kidney selling. So I’ll try.
The rest of the entry is an argument attempting to justify an actual ban.
“I start from a position that assumes prohibition creates black markets, massive price increases, and then crime to pay for the product…followed by organized crime to victimize everyone.”
Actually, you start a little further back from that. You start from an assumption that a market in human organs should exist in the first place.
“This sort of behavior certainly sounds abhorrent. Still, on what ethical basis would any of us feel justified in legally restricting two consenting adults from entering into a contract with one another?”
The “ethical basis” would be the “abhorrent” part.
Per Alex Russell, not “abhorrent” in the sense of “icky” or “I don’t like it” or “it makes me feel all squirmy”. “Abhorrent” in the sense of “inherently lending itself to exploitation”. Abhorrent in the same way that letting people sell themselves into chattel slavery would be abhorrent.
I think it’s pretty obvious that most people will not sell their own organs for money unless they’re fairly desparate. I doubt many, or any, folks here would sign up for it. To me, it’s pretty f**king clear that having to sell your own organs to get by is pretty degrading.
The analogy to prostitution is, IMO, not far off. Do you all know anyone who’s had to turn tricks in order to get by? How’d they feel about it?
“Preserving the option” for poor people — people who, in our culture, are therefore without power or advantage of any kind — to sell pieces of their own bodies in order to make it is a pretty f**king perverse way to help them out. It’s not a form of “freedom” that anyone should have to endure.
The world of human relationships cannot and ought not be reduced to economic transactions. People aren’t meat.
It’s freaking astounding to me that this even needs to be argued, but since nobody else seems to be taking it up, I don’t mind doing so.
As far as I’m concerned, “It’s a f**ked up world when people have to sell their own vital organs to get buy” is a complete, sufficient, and persuasive reason not to do it. Because it sucks to live in a f**ked up world. We shouldn’t allow each other to do so if it can be prevented, and in fact it can be prevented.
If you’re intensely concerned about the folks who need the organs, which would be both fine and laudable, sign an organ donor card. If we all did it, the whole discussion would be moot.
“The rest of the entry is an argument attempting to justify an actual ban.”
Fine. Sign me up for a ban.
It should be against the law for people to sell their own vital organs for money.
People who solicit organs for money should get 20 years, no parole. Their personal wealth should be liquidated, lock stock and barrel, and given to the folks whose organs they purchased. The donors should be punished not at all.
That’s my take on it.
When you enlist in the military you do their bidding within the rules of their law; which does include severe penalties for going AWOL, desertion or insubordination to a superior. This is not so structurally different than entering into a servitude contract where similar infringements on your liberties are also agreed upon by both parties in advance.
Maybe not structurally different, but so what? They’re different in that one can be justified for maintaining military order necessary for defending the country and the other can’t.
There seems to be a tendency among self-described libertarians to overlook obvious practical concerns when it helps support their idealistic or ideological preferences. The world becomes a big abstraction where people and their sufferring don’t matter in the face of Wonderful Abstract Libertarian Principles.
This sort of behavior certainly sounds abhorrent. Still, on what ethical basis would any of us feel justified in legally restricting two consenting adults from entering into a contract with one another?
The Right to Private Contract gets trotted out to justify all manner of ugliness. Contracts aren’t simply useful in a great many endeavors; they are part of the fabric of the universe. And, really, who are we, mere humans, to form governments that might limit the Wonders of the Contract, to supress nature, itself? These mere concerns for the well-being of our fellow man cannot stand in the face of the All-Mighty Contract!
You know, it was all so obvious all along. Why didn’t anyone consider that selling your kidney was a type of Contract? It’s okay! It’s a Contract! …See?
(I apologize for my tone. I used to be one of those guys, so it annoys me tremendously.)
russell – Actually we are meat. Or we are souls that live in meat, depending. And some of us could use meat organ transplants. And some can provide them, or not.
Slavery is the permanent loss and subjection of a person’s will and freedom and rights and destiny to another person. To sell a kidney for money that one receives for one’s own reasons is not, because a whole human body and a kidney happen to be made of meat, a fraction of that loss of rights and own life; it is exactly none of that, just as to sell one’s hair or plasma is not a more infinitesimal fraction of that, it is none of that. The objectionability of slavery and the reason why slavery is intolerable is because of the nature of slavery, of a person’s right to his or her own life – not because of an intolerability of the idea of meat sales.
“If we all had organ donor cards this question would be moot” – not quite, even under that assumption, if someone needs a kidney sooner than we happen to die. And to simply retire to that is to retire to an imaginary world, as far as kidney supply, and say that organs ought to be available without this and you cannot be made to leave on this matter if it would mean tolerating something horrifying. Not to the people who do it. To you.
Actually I have known three people who have been prostitutes. One still does it.
I couldn’t disagree more with this post, and the apex of the disagreement is that someone is said to now deserve twenty years without parole and the total forfeiture of his or her property because he or she has grievously offended your sense of rightness – because “it sucks to live in a f**ked up world.” John Stuart Mill said something about this notion of “social rights”. Let me answer, with equal fire behind it: For offending “the way the world should be”, in my feeling or yours – and not having hurt anyone or violated anyone’s rights – purely for outraging me or you – a person deserves not. One. Day. In. Jail.
If you’re intensely concerned about the folks who need the organs, which would be both fine and laudable, sign an organ donor card. If we all did it, the whole discussion would be moot.
“The rest of the entry is an argument attempting to justify an actual ban.”
Fine. Sign me up for a ban.”
I’ll just add: me, too. I would be significantly happier with a law that required organ donor participation with the only exclusion being religious reasons. At the least it should be the default with the ability to opt out rather than the requirement to opt in.
hairshirthedonist – I’m not a libertarian making that sort of worship of Contract about kidney sales, myself, and it doesn’t have to boil down to that question. For me the crux of the question centers around the fact that this involves a short-term risk of surgical/post-surgical problems but then apparently little or no drawbacks for having done it. Surely, in my view, that – whether the activity is actually bad for you, or is actually destructive to one’s interests if one engages in it, and how much it is – is the defining thing as to whether the activity should be called exploitative or exploitation. Begging the question of that, and saying it’s supposedly a matter of worship of almighty Contract excusing exploitation, seems to me to tack away from the center question, which I don’t think is really branded.
Marty – I would also support the opt-out requirement or the mandatory organ donation on death absent religious objections. Note that I can imagine this being the case simultaneously with the question of kidney sales.
Two comparisons, before I get up and get busy, to show that “one size fits all” needn’t apply:
We restrict “loan sharking”, loans at very high interest, because a person at need entering into such nightmare loans is crippling himself or herself to a degree we find excessive. But we do let people get loans. People take risks for money or for other reasons. It is not obvious that the iatrogenic/medical-error risks of the surgery, or the evidently quite small risk incurred by losing one kidney, puts a kidney sale out of the scale of risks that we should accept that people take.
The question of selling a hand would be a different question: no matter how good a mechanical replacement (and would you get one?), you would be giving up the use of one hand. This would be a downside-taking, literally a crippling one, that we might decide was too much, along the lines of not letting a person go to a loan shark. The loss of one’s second kidney doesn’t entail this sort of curtailment of options.
“russell – Actually we are meat. Or we are souls that live in meat, depending.”
Yes, that’s true. But as I see it, the “depending” part means that we should not treat each other as meat.
Your comments on the distinction between selling a kidney and selling yourself into chattel slavery are apt, however I note that they’re less relevant to, frex, selling yourself into indentured servitude, which is something we no longer tolerate.
Allow me to also say that I appreciate your point of view here:
“For offending “the way the world should be”, in my feeling or yours – and not having hurt anyone or violated anyone’s rights – purely for outraging me or you – a person deserves not. One. Day. In. Jail.”
You’re quite right to note that the basis for my objection to selling organs is rooted in my understanding of the proper moral relationship between humans. You’re also quite right to note that not everyone will share that.
My language in this thread has been somewhat strident. To some degree, that’s a liberty I’ve granted myself — a self-indulgence if you will — because I know that my words will have absolutely zero chance of affecting actual public policy. We’re all just talking around the water cooler here, and that gives us, perhaps, some room to vent.
My language is also, deliberately, strong because, to be honest, I hadn’t really seen the basic moral quandary of organ selling discussed, and IMO it’s a pretty important part aspect of the debate. The conversation seemed to center on either a pragmatic calculus — a risk/benefit analysis — of what the seller might get out of it, or a libertarian argument that selling your own bodily organs should be considered simply another form of contract between consenting people.
Both of those arguments fail, IMVHO, to account for the brutal and dehumanizing aspect of selling yourself off by the pound to the highest bidder.
I’ll go perhaps one step further afield in the interest of trying to explain where I’m coming from.
To me, the most toxic aspect of American culture now is the tendency to view all social interactions as various forms of commercial contract. We live in a society whose most urgent social impulse is to monetize everything that isn’t nailed down, and even most of what is nailed down.
Our goal as a nation appears to be to turn the entire freaking given world into money.
The end result of this will, IMVHO, inevitably be a brutal, cruel, and callous culture. IMVHO, we’re already there.
Selling your bodily organs just seems like another species of this, to me.
I appreciate your objection to having public life governed by the whims of what some folks find personally offensive. I recognize that my argument is open to that interpretation.
What I’ll say is that we all do, or at least ought to, draw the line somewhere.
Selling your organs for money falls on the other side, from my point of view.
Fortunately for us all, my influence on public policy is negligible.
Thanks –
“Maybe not structurally different, but so what? They’re different in that one can be justified for maintaining military order necessary for defending the country and the other can’t.”
So the means are okay as long as the ends are justifiable – which you say they are in this case. You don’t have a problem with selling yourself, just that it has to be for the ‘right reason’. The ‘right reason’ in this case is that there is a human being dieing whose life this transaction could save.
The Right to Private Contract gets trotted out to justify all manner of ugliness.
“Ugliness” is apparently anything which produces an end you do not agree with but whose means you admittedly have no problem with, as in the case of military contract.
These mere concerns for the well-being of our fellow man cannot stand in the face of the All-Mighty Contract!
Your fellow man has his own set of concerns that are subjective to him. He seeks only to better himself by signing the contract.
You know, it was all so obvious all along. Why didn’t anyone consider that selling your kidney was a type of Contract? It’s okay! It’s a Contract! …See?
The paper merely represents the intentions of the signers. I’m not sure everyone IS considering the intentions of the donor. If you were, you’d let him express it with his signature rather than substituting your preferences for his.
The difference is that the long term harm of slavery is demonstrable, while the long term harm of selling your kidney is not (or at least has not been demonstrated).
Surely, in my view, that – whether the activity is actually bad for you, or is actually destructive to one’s interests if one engages in it, and how much it is – is the defining thing as to whether the activity should be called exploitative or exploitation. Begging the question of that, and saying it’s supposedly a matter of worship of almighty Contract excusing exploitation, seems to me to tack away from the center question, which I don’t think is really branded.
I agree, Alex. I was responding to an argument that seemed to turn on “worship of almighty Contract excusing exploitation.” And it was not yours.
The ‘right reason’ in this case is that there is a human being dieing whose life this transaction could save.
That’s certainly a valid argument, but not one that I recalled you explicitly making, my good pencil. If I missed that, my apologies.
“Ugliness” is apparently anything which produces an end you do not agree with but whose means you admittedly have no problem with, as in the case of military contract.
Okay. How about “unnecesary ugliness?” There is some amount of ugliness that goes along with military service. But without it, we have no defense of state. Without a state, we have no state defense of person or property. It’s an imperfect world, I know. That doesn’t justify all ugliness, but it does some.
Your fellow man has his own set of concerns that are subjective to him. He seeks only to better himself by signing the contract.
That’s nice. Sometimes people are exploited, and other people would like to prevent that. Just show that there isn’t a potential for a level of exploitation that would justify a ban. Maybe there isn’t. I don’t claim to know for sure.
The paper merely represents the intentions of the signers. I’m not sure everyone IS considering the intentions of the donor. If you were, you’d let him express it with his signature rather than substituting your preferences for his.
People, by way of law, prevent others from doing damage to themselves for various reasons. Sometimes it’s because of the potential for exploitation due to an imbalance of information or resources that can’t otherwise be compensated for. I think that’s okay. Maybe it’s not necessary in this case, but I don’t have a problem with it as a matter of general principle.
Is that lights out, then?
That was good talk, anyway.
Less radical then either mandatory organ collection from the deceased or the creation of an organ market would be to switch driver license sign-up as an organ donor from optional to the default.
As effort thresholds tend to do, this should greatly increase participation & hence organ availability while allowing opting out for whatever personal reasoning applies.
That it also avoids the unattended consequences of establishing another humans-as-means market should appeal to the Burkeans in the audience.
“Less radical then either mandatory organ collection from the deceased or the creation of an organ market would be to switch driver license sign-up as an organ donor from optional to the default.”
And it’s almost as if this has been mentioned various times before in this thread.
The difference is that the long term harm of slavery is demonstrable, while the long term harm of selling your kidney is not (or at least has not been demonstrated).
You’d better coordinate messaging with the other conservatives out there. The argument now is that being sold into slavery and transported to America rescued black people from generations of misery in Africa, and that over the long run they were better off.