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July 31, 2009

Comments

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.

Those we questioned directly said that they would not recommend that anyone sell a kidney. In answer to our query as to why they had themselves sold a kidney, the most common words they used were majboori (a word that arises from the root jabr, which means a state that is beyond one’s control) and ghurbat (extreme poverty). One man expressed anger at his younger, unmarried brother, who had also sold a kidney despite his advice that das saal zalil ho ja par gurda na day (even if you have to suffer humiliation for ten years, do not give your kidney). He said that he had done it for the sake of his children and added—perhaps as a salve to his conscience—that at least he had “not killed anyone.” Another vendor’s advice to others was that bhookay raho, gurda na do (stay hungry if you have to, do not give your kidney), and a female vendor compared selling a kidney to apnee nilami (auctioning herself).

...Following the nephrectomy, almost all of them reported perceptions of significant deterioration in their physical health and an inability to work as hard as before, even as they mostly failed to escape the cycle of crushing debt. Similar findings have been reported in the handful of studies undertaken on paid, unrelated “donors” in India and Iran. Our screening also revealed significant psychological repercussions, commonly expressed as a sense of profound hopelessness, a perception of the self as somehow halved and incomplete following the nephrectomy, and constant anxiety for the remaining kidney.

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).

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

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.

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.

Fetuses don't arrive in the doctor's black bag, either

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!

Possibly an attempt to bring this conversation back on topic?

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.

But then, you started it by electing to make as if you were really as absolutely ignorant of human biology

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.

So you were being cryptic again.

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.

So mischaracterizing arguments you disagree with in order to call your interlocutors childish is a sign of maturity these days?

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?

kind of backfired on 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.

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.

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.

What counts as schlocky?

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:

[...] Iatrogenesis is a major phenomenon, and a severe risk to patients. A study carried out in 1981 more than one-third of illnesses of patients in a university hospital were iatrogenic, nearly one in ten were considered major, and in 2% of the patients, the iatrogenic disorder ended in death. Complications were most strongly associated with exposure to drugs and medications.[15] In another study, the main factors leading to problems were inadequate patient evaluation, lack of monitoring and follow-up, and failure to perform necessary tests.[16]

In the United State alone, recorded deaths per year (2000):

* 12,000—unnecessary surgery
* 7,000—medication errors in hospitals
* 20,000—other errors in hospitals
* 80,000—infections in hospitals
* 106,000—non-error, negative effects of drugs

Based on these figures, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. Also, there is a wide margin between these numbers of deaths and the next leading cause of death (cerebrovascular disease).

This totals 225,000 deaths per year from iatrogenic causes.

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.

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."

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:

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.

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:

"Markets are one economic arrangement humans have invented, but they've invented a variety of others that have worked for their cultures as well."
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.

By the way, does your blog offer a way to view all posts by one particular author? "
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:

[...] 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.
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:

[...] 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."

At July 31, 2009 at 05:06 PM I wrote:
[...]

"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.

In the July 31st, 6:16 p.m. comment, I wrote:
[...] "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.

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:

Markets don't exist to, they exist because, they weren't intentionally created.

CharlesWT wrote:

Exchange, i.e. markets, exist in all human societies. More explicit in some than others.

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:

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?

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.

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