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July 31, 2009

Comments

There are all kinds of markets. Rush hour traffic is a market in time. A large number of people have decided that it is worth spending a certain amount of their time to drive their car in a particular geographical area during a particular time of day. There are occasional market failures due to weather, traffic accidents or the president comes to town and you are forced to spend a great deal more than you intended to.

An example of a non-monetary market. But, then, time is money.

And then there are the bar and nightclub markets. Are those "meet" or "meat" markets?

Gary,
Thanks for the explanation of your views. I'd first hasten to point out that I wrote about "the definition of coercion you _may_ have in mind". I try, especially when you are involved, to avoid mindreading, and I'm sorry if this phrasing doesn't adequately express my attempt to avoid suggesting that I know precisely what you mean when you write

"That's not coercion; they can, as you say, quit school, and there are plenty of other schools in Japan, are there not? You set down requirements that your students either agree to abide by, or don't agree to, and go elsewhere."

If you go to the Stanford Encyclopedia of Philosophy article I mentioned, you will see that there are are those who take many of the points you make about coercion. However, there are a few points from the article that might be of interest.

The first is this

"Sometimes the term “coercion” is used in popular speech with a quite broad sense. For instance, one hears “coercion” used to describe social pressures (e.g., the need to conform to peer expectations or to placate one's parents); or the constraining or manipulative effects of advertising, one's upbringing, or the structuring of society more generally (e.g., the necessity of participating in a capitalist economy). It is also sometimes treated as a quite general concept encompassing almost any sort of interpersonal infringement on one's rights. Such uses are not wholly foreign to philosophical discussions (see, e.g., Ripstein, 2004). Nonetheless, the following discussion will focus on a narrower sense of the term more in line with its use by major historical philosophical writers and contemporary theorists alike. This usage will rule out, by stipulation, such things as mere disapproval, emotional manipulation, or wheedling. (What is “ruled in” is subject to dispute, as is discussed below.) This minimal setting of boundaries still leaves considerable room for disagreement over how best to understand coercion's workings, its preconditions, and its effects."

If one accepts a definition of coercion as encompassing the utilization of an institutional framework to force a person/persons to commit certain acts, school is coercion, even though students can, as you point out, quit school or transfer. You stated that you accept Sebastian's formulation that

"I'm not arguing that it is impossible for any market anywhere to be coercive. I'm arguing against the idea that markets are by nature coercive. They aren't. They are much less coercive 'by nature' than most human institutions. Can they be used in a coercive fashion? Sure. But are they definitionally coercive? No. And they are less definitionally coercive than governments, families, and most religious structures."

I'm not sure precisely what Sebastian's definition of coercive is, though I tend to think that the adjective can encompass a wider range of situations than the noun, so that something can be coercive, but if it fails to force the coercee to change his/her behavior, it is not 'coercion' per se. As I mentioned, my own definition of coercion is where the coercer substitutes his/her will for that of the coercee, which is why I haven't participated too much the kidney debate here because I think one knows too little about the will of the participants.

This definition goes further than yours concerning power imbalance as defining coercion, but I feel more comfortable with that than trying to define what power imbalance is sufficient to define something as coercive. But I think even this definition encompasses my own feelings about how most modern day education is inherently coercive, because the power imbalance between the teacher and the student seems to be large enough to be covered by your definition. At any rate, I don't think that coercion is definitionally immoral, just that it requires extra scrutiny because it is so powerful. However, I do feel that while coercion is not inherently immoral, exploitation is, so my problem with kidney sales is that there seems to be far too much scope for exploitation. This 2004 WSJ article may be of interest.

I'm interested in discussing coercion in this light, but it is admittedly orthogonal as to whether kidney sales are coercive.

My definition of coercion is that it takes place when the coercer threatens, if the coerced does not comply, to make the coerced worse off than if the two of them had never interacted. The threat may be implied or explicit, but it must exist.

Simply making an offer, and walking away if it is not accepted, can NEVER be coercion.

You can, of course, exploit somebody's pre-existing circumstances, in a non-coercive manner. But that's something different, and is, essentially, the basis of all transactions. Hell, Burger King does THAT to me, when I'm hungry.

"Hell, Burger King does THAT to me when I'm hungry."

I find THE Burger King, the one in the commercials with the smile frozen on his face, extremely threatening.

When he leaves the screen, I check to see if I still have both of my kidneys.

All the definitionalism regarding what is or is not "coercion" seems to be getting off the rails a bit. Isn't it fairly clear that what we're discussing is poor people being far more likely than others to do something highly regrettable for financial reasons? Whether that constitutes coercion or not, people can think that it's a problem sufficient to oppose the sale of kidneys.

So the question is: Is that a moral and/or practical problem with kidney sales that outweighs the potential benefits? (There may be other questions, as well. But I think that's "the" question when it comes to the concern regarding the possible effects on the poor, coercion or not.)

"Isn't it fairly clear that what we're discussing is poor people being far more likely than others to do something highly regrettable for financial reasons? Whether that constitutes coercion or not, people can think that it's a problem sufficient to oppose the sale of kidneys."

I keep trying to address this. The problem is that the scientific evidence doesn't seem to suggest that it is *in fact* highly regrettable. People who donate kidneys now don't seem to have a higher risk for future kidney disease or failure than those who don't donate. They don't seem to have a higher mortality rate if they do get kidney disease.

So it doesn't look like giving a kidney up actually is highly regrettable unless you are talking about some sort of non-health thing.

I suspect that for a lot of people the issue really isn't a health issue. I suspect that a lot of people have a visceral reaction to the idea that isn't really about the health outcome of the kidney donor. And that's fine. I'm actually very open to the idea that visceral reactions are worth attending to. But we can't even start looking at it with everyone claiming to be worried about the health of the donor (health of the kidney patient mostly sidelined or hand-waved in this discussion except by Gary) when there isn't much if any evidence that the donor is in much actual danger.

Is it absolutely definitely ZERO actual danger? No. But very few human activites have absolutely definitely ZERO actual danger, and many jobs that the poor end up taking have at least as much annual danger as giving up a kidney.

The problem is that the scientific evidence doesn't seem to suggest that it is *in fact* highly regrettable.

Perhaps that is the case. I'm just trying to point out what argument should be had, as opposed to niggling over what the word "coercive" means or how well it applies to something that is pretty well understood, regardless. At this point, I'm not arriving at a conclusion, just trying to clarify what I think the argument is. Of course, I could be wrong about that, too.

Regardless of the appropriateness of the use of the word "coercion" some people think kidney sales would present a big problem for poor people desperate for money, and others, including you, Sebastian, don't. So forget about coercion and discuss the problems directly (which is what you were doing, BTW, Seb, so I say keep it up - though the tread is probably dead, anyway).

" Isn't it fairly clear that what we're discussing is poor people being far more likely than others to do something highly regrettable for financial reasons?"

What, like taking a shitty job? Like living in a rat infested apartment? You're not offended by "coercion", you're offended by "poverty". You don't have to subsume all the evils of the world under one word, you know.

John Spragge - No, actually my argument does not contain the assumption that a market mechanism is the only way to increase access to transplant kidneys. It is not there. (After all, my very next sentence after the one you quoted was, "By the way, I would also support the idea of making organ donation on death mandatory absent religious objections." By "also" I mean not just alternatively but potentially simultaneously.) My idea has been that kidney sales are a way to increase the transplant supply, that would add up to a net benefit.

I have no objection to your other suggestions, either, although the suggestion of offering free medical care, a public health package, etc. wouldn't jibe well with my own preferences - because I'd support a universal health care arrangement, not just for them but for everyone, which would seem to address a lot more unfair unequality than banning kidney sales would.

I'm afraid I can't join you on your special focus on powerful people abusing their power and people with thick wallets. Whatever alternative arrangements were in place or were simultaneously in place, the difference between banning kidney sales and allowing them would never be zero; it wouldn't be a matter of an available kidney being just as available but simply having become available by one route or the other. Cash offers motivate people as other things will not. (The matter of the money going to the people who would want it is not a neutral or a negative matter either.) The effect of banning kidney sales, as opposed to not banning them, is that some people who could have paid for a kidney will not get one, and some people who were willing to sell one for the significant amount of money will not get the money. In the vast majority of these cases, no such abuse of power as you described the possibility of would have been involved. I cannot find this result preferable.

This focus on special abuse of wealth and power being the determining factor here reminds me of what I have thought of as bad examples of reasoning about the possibility of legalization of marijuana or other things, where people have fixed on particular possible results of the new arrangements or things that might happen under it - somewhere, sometime - and, because they find those things intolerable, declaring the entire regime an unsound idea - completely without reference to the rarity or unlikelihood or partiality or pure hypotheticality of the intolerable case they have fixated upon. But I don't think I'll persuade you about what you're finding central here. I'll just say that I'm concerned with the general effect.

Brett-

I found your example of the person hanging off the cliff very useful. One thing I get from it is that the people talking about markets being coercive on poor people probably mean mostly that the situation is coercive - the cliff is coercive. Or at least this is most intelligible, but it probably lines up well with their sense of things.

I can understand this. What's fascinating is the reactions to the problem. I can understand Gary's mention of a negative income tax arrangement, as a response, because this would address the coerciveness by shallowing the cliff or making it less steep (all possible cliffs). There'd be more of a limit on what kind of a corner people could be in. The math is tricky and might be unworkable, but in intent this is comprehensible.

What I find amazing in this conversation, though, is that people are wanting to address and apparently combat the coerciveness of the cliff you're hanging off of by forbidding you to pay a passerby to lift you out of the trouble. Precisely because you have to pay, and calling that the coercion. And looking askance at the passerby for being open to the deal... as if s/he is the coercer - the cliff.

I've been polite to the coercion frame in this thread, on an "even if" basis, because I do believe in cliffs from time to time. But the rest of the way this is picked up is a bit confused.

(John Thullen - No kidding, the new Burger King guy makes my @#$%&* blood run cold.)

Thanks for your expansion of your views, liberal japonicus. I notice nothing significant I disagree with.

Brett: "Simply making an offer, and walking away if it is not accepted, can NEVER be coercion."

That, of course, I disagree with. You simply assert it. It's an article of faith with you. That's nice.

JT: "I find THE Burger King, the one in the commercials with the smile frozen on his face, extremely threatening."

Me, too. If I were in a focus group on any of those commercials, I'd explain that that plastic thing frightens me inexplicably. Perhaps it's an "uncanny valley" effect, although the plastic doesn't seem all that close to human to me.

Incidentally, everyone who is really, really concerned about helping people in need of kidneys get them can go right here and give one of yours to a compatible donor right now.

Silly Phil, the point isn't that people are suffering for want of kidneys: the point is that demanding organ markets allows conservatives and libertarians to feel good about themselves by claiming that liberals are fuzzy headed. I mean, if they actually cared about the organ shortage, we'd see serious proposals like making organ donation opt-out rather than opt-in or special tax breaks for everyone with an organ donor card.

@Sebastian:
I keep trying to address this. The problem is that the scientific evidence doesn't seem to suggest that it is *in fact* highly regrettable. People who donate kidneys now don't seem to have a higher risk for future kidney disease or failure than those who don't donate. They don't seem to have a higher mortality rate if they do get kidney disease.

This neatly elides the fact that we are talking about paying would-be donors to undergo major intrusive surgery. As has been mentioned upthread repeatedly. Declaring kidney donation to be of negligible risk by focusing strictly on the ability to survive with a single kidney if all goes well with the donation is slightly disingenuous.

Turbulence, I'm a liberal by just about any sorting, and I would support the opt-out arrangement - in fact more than that - and etc. ... and there is an argument for kidney sales that is about the transplant supply.

And Obsidian Wings is where I come when I want to see something other than accusations that someone else's arguments are only about the other side wanting to feel good by slamming their other side. Perhaps optimistically, but then again often here the focus really is on people's arguments on their merits.

"Silly Phil, the point isn't that people are suffering for want of kidneys: the point is that demanding organ markets allows conservatives and libertarians to feel good about themselves by claiming that liberals are fuzzy headed."

I thought the point was to let liberals feel good about themselves while pretending to care deeply about protecting the poor people that they hurry by on the street every day.

Or maybe we are actually trying to have a good discussion about the issue without name calling.

I've linked to the science which suggests that kidney donation, if screened for general health, doesn't increase risk for further kidney disease.

So, as science-respecting policy people are you all dropping that particular concern, or at least questioning it seriously? Or is there something else going on?

I'm going on with the argument assuming that the science is correct.

Since kidney donation does not appear to cause increased risk of kidney disease, kidney sale should not be banned on the grounds of being unfairly exploitive in the long term. The benefit to the kidney patient is enormous. The benefit to the kidney donor is the money received. The long term detriment appears to be zero or vanishingly small.

So the question shifts to short term issues. I don't know exactly what the short term surgical complications risk is--but in general I would suggest that if it is in the same risk zone as an elective surgery like a breast implant surgery, that it doesn't make sense to outlaw it on that basis either.

Is there evidence that it is substantially more risky than elective procedures that we let people pay doctors for?

Turbulence, I'm a liberal by just about any sorting, and I would support the opt-out arrangement - in fact more than that - and etc. ... and there is an argument for kidney sales that is about the transplant supply.

And Obsidian Wings is where I come when I want to see something other than accusations that someone else's arguments are only about the other side wanting to feel good by slamming their other side.

Second both motions. Think of the latter as the Spirit Of Hilzoy.

"I've linked to the science which suggests that kidney donation, if screened for general health, doesn't increase risk for further kidney disease."

And I've linked to the stats on iatrogenesis. So, So, as a science-respecting policy person are you dropping that particular concern, or at least questioning it seriously? Or is there something else going on?

Is there evidence that it is substantially more risky than elective procedures that we let people pay doctors for?

IANAD, but one is inclined to suspect, perhaps wrongly, that removing a functioning organ is more risky than inserting a prosthesis under the skin, glands, or muscles.

I can't say that I'm comfortable creating circumstances whereby people may feel they have no choice but to undergo major elective surgery. Even if the risks are no more drastic than that of elective cosmetic surgery (something I am nowhere near as comfortable taking for granted as you appear to be; five minutes of poking around found me a study citing 7-9 weeks of sick leave on average following donation), it still amounts to compelling people who will be disproportionately drawn from a particular social strata to gamble with their health for the benefit of people who would presumably be disproportionately drawn from a higher one.

This also ignores our current medical system; a market for kidneys that did not include sufficient regulation to ensure followup visits and care for donors would presumably see more complications from donors who couldn't afford them on their own (or for that matter couldn't afford to convalesce as long as they should).

"...but in general I would suggest that if it is in the same risk zone as an elective surgery like a breast implant surgery, that it doesn't make sense to outlaw it on that basis either."

Now, I don't have stats on that, and I am, in fact, inclined to agree with you, but I do strongly suspect that there's a greater iantrogenic risk than breast augmentation surgery, or most cosmetic surgery, on the grounds that when I had kidney surgery, it was a three day stay in the hospital with my kidney exposed externally, and a tube running into it, which I'm inclined to suspect makes one more exposed to both potential infection and serious problems than something that can be done on more minor organs or as an outpatient procedure.

But, I repeat, I'm just guessing on that, and I don't disagree with your basic point; I'm simply suggesting that there may be some differences in types of surgery, as regards risk, worth considering in a serious discussion.

I'd, incidentally, just as soon never hear the term "renal colic" ever again. Nor have nurses consistently be inattentive enough to not empty out the bags that the tube from your kidney goes to so that they back up.

What, like taking a shitty job? Like living in a rat infested apartment? You're not offended by "coercion", you're offended by "poverty". You don't have to subsume all the evils of the world under one word, you know.

Huh? Are you addressing me, Brett? I don't recall discussing what does or does not offend me. I'm just saying that the situation people are arguing about doesn't have to be a matter of coercion for it to be a problem, so let's just discuss the problem, as in "what I think will happen is this," and stop trying to decide if it is or is not a matter of coercion.

If you want to know, I'd say that both poverty and coercion offend me, at least in the sense that I don't like them or think they're good. Do you like those things?

As far as your argument goes, the fact that poor people suffer in (arguably) unavoidable ways doesn't imply that they should also suffer in avoidable ways. If you want to argue that kidney sales will not result in undue or significant suffering for poor people, go right ahead.

But bringing up the fact that poverty sucks in a bunch of other ways doesn't seem relevant, unless I'm somehow missing your point. Are you saying that, since being poor sucks, we shouldn't worry about the negative effects of things on the poor, or what?

"...would presumably see more complications from donors who couldn't afford them on their own (or for that matter couldn't afford to convalesce as long as they should)"
So, what are they spending that ~$80,000 they got for the kidney on?

Alex, Seb, and Gary: you're all right, I was way over line. I don't know what I was thinking. Thanks for the gentle correction and my apologies again.

"And I've linked to the stats on iatrogenesis. So, So, as a science-respecting policy person are you dropping that particular concern, or at least questioning it seriously? Or is there something else going on?"

Umm, don't I deal with this when I write "So the question shifts to short term issues. I don't know exactly what the short term surgical complications risk is--but in general I would suggest that if it is in the same risk zone as an elective surgery like a breast implant surgery, that it doesn't make sense to outlaw it on that basis either."

You also write "But, I repeat, I'm just guessing on that, and I don't disagree with your basic point; I'm simply suggesting that there may be some differences in types of surgery, as regards risk, worth considering in a serious discussion."

Sigh. Well yes. Of course. But it has taken me days to get the discussion to the point where I don't have to defend against the "taking the spare kidney=increased chance of kidney disease" question. And we're still talking about coercion when none of the people talking about how important it is to avoid coercion have bothered to demonstrate that there is a more-serious-than-normal-for-ways-that-poor-people-get-money risk. Not to mention fending off accusations of not caring for the poor (unsupported by say any showing of special risk).

We wouldn't have even gotten to the risk-of-surgery-itself question if I hadn't done some minimal research and discovered that the alleged risk of increased kidney disease is apparently illusory (or at the very least much less significant than was assumed on this thread).

So yes, I'd love to talk about whether the risk of the surgery itself is a big enough deal to ban the sale of kidneys. It might be. It might not be.

The ebb and flow of the argument has essentially gone:

Kidney Sale is inherently exploitive.

What makes it exploitive?

The fact that giving up a kidney makes you more susceptible to kidney disease because you now don't have a spare.

That doesn't appear to be true: cite.

People who are talking about kidney sales in anything but the most negative of terms just want to exploit poor people.

But I just showed that it doesn't cause any long term harm.

Well what about the risk of surgery itself? [note this comes four full days into the discussion and with lots of other baggage about why we have 2 kidneys implicating the same long term effect questions]

At least two other people bring up the alleged long term damage in increasingly shrill rhetoric.

We get bogged down in coercion at least twice with sidenotes in coercion maybe not being a bad thing.

Again I mention that the long term damage doesn't seem to be serious if it exists at all.

Finally a few people seem to accept it, though I'm still not sure.

And NOW we can get to the issue of whether or not the surgical risk is enough to ban it.

And note that I'm at least trying to engage pretty much everyone on the anti-kidney-sale side, while you are engaging about one or two (with a side digression with lj). So yes, by all means I'd LOVE to talk about the real issues if we can actually get there.

"So, what are they spending that ~$80,000 they got for the kidney on?"

Drugs and hookers! After all, if the poor didn't make bad choices, they wouldn't be poor, would they?

"I don't know what I was thinking."

I think it's a pretty natural tendency for most of us, in our heads, to laugh and and make fun of our opponents if they make or hold what we consider to be silly arguments or beliefs.

Sometimes it's easy to forget that we try to restrain ourselves in expressing such views here.

It's so easy to hit "post" without pause, after all. We'd probably have a better internet if we had to crank a handle fifty times to get each comment to post. Someone should invent a rubber-band USB plug-in!

(Now if only John Emerson came by more frequently, he could pop up to denounce us all for the futile pointless harm such restraint does. If not, there's usually someone to make the argument about the downside of civility. It prevents realistic appraisals! It's a pretense that shouldn't be engaged in! And it hurts my head to not fully express my Inner Child!)

"The ebb and flow of the argument has essentially gone...."

Well, that's what comes of bothering to argue with a number of people with a variety of views, isn't it?

I hear the Continental Congress took up a lot of time, too, and they had more motivation and more important issues to deal with.

I'm also reminded of 1776:

Lewis Morris: [as John Hancock is about to swat a fly] Mr. Secretary, New York abstains, courteously.
[Hancock raises his fly swatter at Morris, then draws back]
John Hancock: Mr. Morris,
[pause, then shouts]
John Hancock: WHAT IN HELL GOES ON IN NEW YORK?
Lewis Morris: I'm sorry Mr. President, but the simple fact is that our legislature has never sent us explicit instructions on anything!
John Hancock: NEVER?
[slams fly swatter onto his desk]
John Hancock: That's impossible!
Lewis Morris: Mr. President, have you ever been present at a meeting of the New York legislature?
[Hancock shakes his head "No"]
Lewis Morris: They speak very fast and very loud, and nobody listens to anybody else, with the result that nothing ever gets done.
[turns to the Congress as he returns to his seat]
Lewis Morris: I beg the Congress's pardon.
John Hancock: [grimly] My sympathies, Mr. Morris.
Some things never change. I'd suggest that internet discussions are among them, but in fact I've noticed the same problems with in-person discussions amongst people who are not all of like mind. And discussions in writing enable us to have a higher quality of discussion, if lengthier, by virtue of being better able to organize and present our thoughts, along with research and citations.

It allows those of us who bother to do so, anyway.

Anyway, going all meta probably isn't helping. So let me recap:

If you are going to suggest that kidney sales should be banned because of exploitation worries about the poor, there are a couple of things we need to talk about.

Benefits: benefit to the person who gets the kidney is enormous. Financial benefit to the kidney donor is likely to be fairly noticeable.

Detriments: Long term--these apparently don't exist or are essentially trivial. So that leaves short term risks.

I would challenge you to consider before we go further what you would consider to be an acceptable level of risk to allow kidneys to be sold.

I haven't looked yet, but my moral intuition would suggest that if the risk of serious complications gets to say 3-5 times that of the fairly invasive elective surgeries I would strongly consider banning it.

This is why: we let people choose to pay for such surgeries and elect to take the risk. In the kidney case we are letting people get paid, so we sure surely allow at least the level of risk that people regularly are willing to pay for.

@CharlesWT:
So, what are they spending that ~$80,000 they got for the kidney on?

$80k? Shirley you jest. My readings over the last few days puts a 1st-world black market figure in the 30-50k range, with a global average down around 10-20k.

I obviously can't say how much legalization would change the price, but I'd like to hear your reasoning for assuming a stable figure twice the black market figure.

Also, to hit the meat of the question, presumably they'd be using the money for whatever drove them to risk their health to get said money. Hopefully they'd factor in adequate post-operation health care and loss of income due to convalescence. But I'd feel a lot more comfortable with the whole idea if we had a more civilized health care system, and/or could reasonably ensure that market regulations would require comprehensive arrangements for such things to be included in every transaction. The donation carries with it health risks, both long and short. Claims that it doesn't appear predicated on presumption of adequate care and convalescence coming out of the operation, and can't be relied on absent that if accounts from oversea kidney sales where such things lacked are anything to judge by.

"$80k? Shirley you jest."
Well, that figure was off the top of my head. However, in an open market, prices might vary widely. A wealthy person with a difficult tissue match might pay a very high price whereas someone with a relative easy match would pay much less.

"$80k? Shirley you jest. My readings over the last few days puts a 1st-world black market figure in the 30-50k range, with a global average down around 10-20k.

I obviously can't say how much legalization would change the price, but I'd like to hear your reasoning for assuming a stable figure twice the black market figure."

That is counting shady middle men. End user purchases have been reported in the $150,000-$200,000 range (difficulty of getting accurate black market figures noted of course), so an in between $80,000 doesn't sound crazy.

Well... yes... but is that 150-200k for just the kidney, or is that parts and services? The CSM article cited upthread mentioned a cost-to-buyer at 140k for the case they looked at from the buyer's prospective, and to my understanding that was including installation.

Again, though, we're speculating on potential white market prices based on unreliable black market prices. My request for a rationale was based on curiosity rather than incredulity - the structure of a hypothetical market would have an enormous effect on prices, as well as standard market variation. "Doesn't sound crazy" seems about the right level of precision for all this...

(And I'll concede I came across as moreso incredulous than curious - I blame my whimsical inclusion of the aeronautic reference for skewing my tone in that direct. Apologies.)

"The CSM article cited upthread mentioned a cost-to-buyer at 140k for the case they looked at from the buyer's prospective, and to my understanding that was including installation."

On this at least I think you are wrong. The cost of putting in the kidney is far far above $140,000.

"Well... yes... but is that 150-200k for just the kidney, or is that parts and services? The CSM article cited upthread mentioned a cost-to-buyer at 140k for the case they looked at from the buyer's prospective, and to my understanding that was including installation."

Does it include a money-back guarantee?

What about coupons? Sales when you're over-stocked! Two-for-the-price-of-one deals!

Buy now, pay later! No interest for the first two years!

Just thinking ahead a bit.

You might be able to get better terms on Craigslist than through a formal dealership.

I'm profoundly concerned by the possible secondary consequences that could arise from the viewpoint that these kinds of transactions are acceptable. (can you buy an option in a kidney, to be exercised at a future date? what happens if the donor changes his mind? etc.)
Posted by: (The Original) Francis | July 31, 2009 at 11:25 AM

I have few worries that a kidney would become a seizable asset, or that options/futures markets in kidneys would spring up...
Posted by: danny | July 31, 2009 at 02:12 PM

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.
Posted by: Min | August 02, 2009 at 03:24 PM

[...]
Patterned after the stock exchange (or perhaps the commodity exchange is a more apt analog), I propose we create, as part of a market driven health reform initiative, a Kidney Exchange. Value maximization will ensure the free flow of kidneys into the most appropriate markets and the most appropriate recipients.

In the interest of fairness and transparency, full reports on each putative “donor” will be submitted to the exchange by medical clinicians who (as is the current practice among medical device researchers) will be paid in stock options in the subjects of their examinations. This stake in the endeavor will ensure commitment to the process. These reports will function as the basis for prospectus and, in the case of those not yet ready for immediate harvest, ongoing quarterly reports.

We would not, of course, limit the purchase of kidneys to those who “need” the actual kidneys, as that too would tend to skew the market. “Need” must be determined through the time-tested criteria of the market: availability of, and a willingness to use, investment capital.
[...]
A Kidney Exchange, less sentimental but more modern, would, of course, put the preference where the invisible hand of the market deems it best (though under Swift’s criteria the IMF, and World Bank would seem to be the sentimental favorites). In this way it would allow, as we do now with private health insurance, that most efficient of instruments, the market, to decide who lives or dies.

Kidney Sales, a Free-Market Approach

:)

Something I haven't seen addressed: for those who support the notion of a market in kidneys, what other body parts would you deem acceptable to sell? Lungs? Arms? Genitals? Hearts?

[The last might fall afoul of suicide laws, but let's assume for the moment that such impediments to the market do not exist.]

In an ideal world with current medical technology, I imagine corneas would be the logical choice, though only after death, as it is the most common type of transplant.

Since there are people who are knowledgeable about the facts of kidney transplantation, I wonder if there is any benefit getting a young kidney versus one with some miles on it. The only anecdote I have is that my horn teacher donated a kidney to one of his best friends, and the combined ages of the donor and recipient were the highest for that transplant center, 145 years which can support Sebastian's point about the relative safety of the procedure.

However, I still feel that the ick factor is so deeply rooted in our psyches that it is not really possible to have a full fledged market in human organs, so that it would have to be constituted in some way so as to shield the participants in some way.

It calls to mind a thread that Andrew participated in where someone was asking why the military holds recovering bodies as such a important task and Andrew was defending it. While logical arguments were made, at its heart, it is an irrational urge, quite possibly similar to the ick factor when we imagine someone taking a part of their body and giving it to someone else.

"But that's something different, and is, essentially, the basis of all transactions."

I think our pal Adam Smith would say that mutual benefit is the basis of all proper transactions.

This is one hell of a weird thread.

There is no freaking way in any conceivable world that a market in kidneys for sale won't become exploitative.

Exploitation is, in fact, pretty widespread and, in practical terms, kind of unavoidable, but it's also no justification for anything.

It's certainly not the basis for any kind of society that any of us should want to live in.

When we get to the point (which, apparently, we may have achieved) that we accept selling irreplaceable body parts as a reasonable and legitimate way for people to address their own poverty, IMVHO we've crossed some kind of f*cked up moral Rubicon.

Blood, hair, sperm, eggs, all bad enough, but your body will make more.

Kidneys are kind of a different kettle of fish.

Isn't that clear?

IF PEOPLE NEED TO SELL A KIDNEY TO GET BY, WE SHOULD JUST HELP THEM OUT.

My two cents.

IF PEOPLE NEED TO SELL A KIDNEY TO GET BY, WE SHOULD JUST HELP THEM OUT.

Without extracting our pound of flesh?

Something I haven't seen addressed: for those who support the notion of a market in kidneys, what other body parts would you deem acceptable to sell? Lungs? Arms? Genitals? Hearts?

To be perhaps crotchety: I'd rather have a decision made just about kidney donation - or just about any particular thing. Rather than detouring as a contributory exploration into "what other things would you be okay with?" - because what good is that, here, except to have one's other acceptances or rejections cast some sort of allegedly revealing light on one's arguments on this specific matter - which I think would be of completely bogus value, if not just propagandistic value, compared to the value of one's specific arguments about this matter?

This is the great entropic trap with all this: we are obliged often to refer to general questions in order to analyze specific matters, but people - especially we people prone to come here and do this - are particularly addicted to going off and judging according to generalities, to the point where sloppiness about the specific applications is so distant as to be invisible. "There, you see, Bart is an Erratic Ponticrabist on general sales and a Ponticrabist just in general! And he'd be okay with X different situation! What to think of his take is clear."

Yes, what to think of other transplant matters is interesting and may be valuable, but I suggest we finish with the matter of kidney sales first, because it's a dangerous distraction - unless there's first some airtight reason why kidney sales can't be weighed on their own, or why answers about other organ sales really might retwiddle the best answer here.

So, what if someone just wants to buy that sports car they've always wanted?

russell, "exploitativeness" has been discussed from enough angles in fair depth in this thread that you should go into more depth about it before making it a premise. What is its shape?

It isn't just poor people who might want to sell a kidney. I might want to, at those predicted prices - well, actually I might qualify as poor, but Sebastian also says he might at those prices, and I don't know, but I think he's doing a fair bit better than me. If Sebastian is indeed doing however quite well, and he decides to sell a kidney for the financial reason, is the thing therefore for us to help Sebastian out? There are a lot of upper-middle-class people or better who could use us, then.

Actually, it might not be the desperate poorest people who are selling the kidneys at all, even. Such people aren't as well hooked up to information as people who have more resources. They might not get to it. It would be more likely to be any given person who wants a car or a down payment on a house. The poorest might miss out. That has been bugging me the whole time about, for example, Kevin Drum's horrified framing of a poverty-stricken family facing Snidely Whiplash standing at the door with a wad of bills in his hand. Why would it be them?

Unless the background assumption is that it would have to be them because only the most desperate would do something "so abhorrent." Which seems unlikely.

But the abhorrence seems to be central to your reaction. (It's possible that you might be folding riskiness in there, too... althought Sebastian has done a lot of research-citing about the implications, or lack of same, of having only one kidney, which seems to take it down to the basic short-term risk of having major surgery.) I'll just say that reliance on basic abhorrence of something, or reliance on its repugnance, in my experience, has usually led to conclusions that I have strongly disagreed with - that are usually imposed without consent on people other than those who are doing the abhorring and seeing the repugnance.

(I was surprised to see you write: "Blood, hair, sperm, eggs, all bad enough..." Bad enough? Those things? Intrinsically, I take it? I have sold plasma for years. It has been a source of extra cash, that has sometimes been very valuable in tight spots. Does this offend you? Do you want to stop me from doing it? Please answer.)

The foregoing would also include my reaction/response to liberal japonicus' point: It's possible that you might be descriptively right about the ick factor in society and its level of influence, but I think I have made clear my view about deference to the ick factor, and my view of its level of contribution to the best answers.

Sebastian was generous about it a ways back (I can't find it now), saying that he saw a value in society attending to such impulses here and there. I am not sure why. I don't. In any case, we do agree on whether it should be a deciding consideration in this question.

"[The last might fall afoul of suicide laws, but let's assume for the moment that such impediments to the market do not exist.]"

They just need to keep working on these.

Also, cloning body parts.

Also, I hear of a certain Wizard, in a place whose name begins with "O."

"Genitals?"

I already get a lot of spam, and see late-night tv ads, that seem to come close to such offers.

"So, what if someone just wants to buy that sports car they've always wanted?"

Ever seen Leaving Los Vegas?

Or even Leaving Las Vegas?

Actually, it might not be the desperate poorest people who are selling the kidneys at all, even. Such people aren't as well hooked up to information as people who have more resources. They might not get to it. It would be more likely to be any given person who wants a car or a down payment on a house. The poorest might miss out.

I hadn't really considered this before, but it does ring somewhat true. I would imaging there would be some amount of bureaucracy to navigate in forms to fill out, places to go for prerequisite testing, records to manage, etc. that most of the poorest among us and some significant segment of the merely not-so-well-off would lack the resources to get through. I don't imagine one would simply show up at the ER, have a kindey removed and walk off a few days later with a check. I think this is a point worth considering.

"But the abhorrence seems to be central to your reaction."

You got that right.

"I'll just say that reliance on basic abhorrence of something, or reliance on its repugnance, in my experience, has usually led to conclusions that I have strongly disagreed with "

Then we're likely to disagree on this topic.

"I have sold plasma for years."

I know a number of folks who've sold plasma. IMO it'd be better if folks didn't have to sell their blood products to make ends meet, but there are worse things to do.

"Does this offend you?"

No, not really.

"Do you want to stop me from doing it?"

Nope.

Why are kidneys different?

It's major surgery, period. There is no risk-free major surgery.

It's not a body part that your body will remanufacture.

You aren't donating into commodity bank, like you do with plasma or sperm, you're generally donating to a specific recipient, which lends itself to folks with a lot of money getting preferred access to other people's body parts.

You know, if you want to sell a kidney for a sports car, I personally find that kind of f*cked up, but I'm not sure you should be prevented from doing so.

I have a bigger problem with people selling body parts to survive, because then you are definitely into exploitation-land.

But basically, IMVHO the whole shooting match -- selling parts and products of your living body for money, for whatever reason -- seems profoundly screwed up to me. And for the record, the "screwed up" part here is the fact that people find themselves in the position where selling pieces of themselves is their best available choice.

Nobody should have to find themselves in that position.

If you feel like a sports car is more valuable to you than a piece of your body, I find that profoundly weird, and I might suggest counseling, but that's your problem.

I don't really feel that way about hair, which is basically dead tissue that you don't need for any particular reason, and that we regularly cut off anyway. If you could find a market for fingernails or toe clippings, same deal.

Blood, sperm, eggs, other parts for sale just seems profoundly problematic to me, on its face.

Just my two cents.

"lack the resources to get through"

The mortgage industry managed to solve that problem with no money down, no proof of income, signature loans...of course it was provided at a premium. I am sure that there will be some enterprising entrepreneurs finding ways to separate the poor from their kidneys while keeping the finder's fee.

"But basically, IMVHO the whole shooting match -- selling parts and products of your living body for money, for whatever reason -- seems profoundly screwed up to me. And for the record, the "screwed up" part here is the fact that people find themselves in the position where selling pieces of themselves is their best available choice.
"

Is it their best available choice, or is it the fastest and "easiest" choice? If you can work two years to earn $50,000, or under go surgery and 2 weeks of recovery for $50,000, which is the best available choice?

I agree that it can be exploitative, but I am not sure that equates to being the "best" available choice, as opposed to the seemingly easiest.

The mortgage industry managed to solve that problem with no money down, no proof of income, signature loans...of course it was provided at a premium. I am sure that there will be some enterprising entrepreneurs finding ways to separate the poor from their kidneys while keeping the finder's fee.

I had similar thoughts after posting my comment. I think it would depend on the controls in place and how much could be done by proxy. And the mortage industry didn't do much targeting of the poor, just people who couldn't necessarily afford what they were buying. I think the people under consideration haven't been homeowners in large numbers.

So, what's up this weekend, jrudkis?

We arrive early Friday morning (3 am). Want to come by my parents house with the brood Friday night (or Saturday)? I have all 7 of us in tow. We leave Sunday to New York.

"If you can work two years to earn $50,000, or under go surgery and 2 weeks of recovery for $50,000, which is the best available choice?"

If you're asking me, I'd say work two years.

But, whatever floats your boat.

Look, the discussion here seems to assume that "low risk" major surgery equates to "piece of cake". Any major surgery invites risk. Any decent doctor will advise you away from unnecessary major surgery.

If you want to undertake that risk to help out another person, due to family connection or plain old altruism, I applaud you.

If you want to take it on to buy a BMW, I'd say your priorities are f**ked.

If you find yourself in a position of undergoing major surgery and removal of a vital organ because it is, frex, the only way to keep from losing your house, I'd say we're all f**ked.

People shouldn't have to sell pieces of themselves to get by. It's kind of hard and maybe pointless for me to push this particular argument forward, because you're either on board with the idea or not. If it occurs to you to wonder if maybe it's not so bad for people to sell their bodies off by the pound to get stuff they want, there's probably nothing in particular that I'm going to say that's going to make much difference to you, and after this post I'll drop it.

But trust me, it's f**ked. The only reason there's even a question is that we live in a brutal, mercenary, dehumanizing, pathological culture.

And it's kind of cute to talk about, but I doubt anyone here is seriously going to sign up to have their kidney removed so they can buy a car. The folks who are going to do that are folks who are up against it financially.

That means rich folks get to buy poor folks' organs. Trust me, that is f**ked.

As always, my two cents.

Want to come by my parents house with the brood Friday night (or Saturday)?

Sure. Send me an e-mail, so we can nail down details without abusing ObWi privileges any further.

russell, you're a persuasive guy. You write like a cold shower on a groggy morning.

"You aren't donating into commodity bank, like you do with plasma or sperm, you're generally donating to a specific recipient, which lends itself to folks with a lot of money getting preferred access to other people's body parts."

This is not, in fact, how UNOS works.

The UNOS Organ Center is available 24 hours a day, every day of the year, to facilitate organ sharing among transplant centers, organ procurement organizations and histocompatibility laboratories across the U.S. The primary functions of the Organ Center are to:

* assist in placing donated organs for transplantation
* assist in gathering donor information and running the donor/recipient computer matching process
* assist with transportation of organs and tissues for the purposes of transplantation
* act as a resource to the transplant community regarding organ-sharing policies

History

The UNOS Organ Center, established in 1982 as the Kidney Center, celebrated 20 years of service on July 15, 2002. In 1984, as more organ types were being successfully transplanted and the sharing of lifesaving organs became more common, the name was changed to the Organ Center. Since its inception, the Organ Center has provided continuous, uninterrupted service to the transplant community.
[...]

Activity

On an average 24-hour day, six organ placement specialists during two 12-hour shifts will:

* place and/or attempt to place 15 organs for transplantation
* process and transmit 12 organ donor matches to waiting OPOs
* add, modify or remove more than 50 patients from the national waiting list
* receive 350 telephone requests from transplant centers, OPOs and laboratories
* spend more than 26 man-hours on the telephone placing organs and communicating matching information.

[...]

When organs are donated, a complex process begins. The procuring organization accesses the national transplant computer system, UNetsm, through the Internet, or contacts the UNOS Organ Center directly. In either situation, information about the donor is entered into UNetsm and a donor/recipient match is run for each donated organ.

The resulting match list of potential recipients is ranked according to objective medical criteria (i.e. blood type, tissue type, size of the organ, medical urgency of the patient as well as time already spent on the waiting list and distance between donor and recipient). Each organ has its own specific criteria.

They also have a pilot program for people who want to donate to a specific person, but who aren't compatible, where such people are paired up with another donor.

Stats on donation by donor relation. Pull down "Living Donor Transplants By Donor Relation" and "kidney."

Most donors are related by blood, due to compatibility issues. Then there are spouses and life partners. Then there are "Non-Biol,unrel: Paired Exchange." I think that translates to "friends." Then there are "Non-Biol,unrel: Anonymous Donations." Then there are "Non-Biological, Other Unrelated Directed."

I don't want to list all the figures -- you can read the chart for yourself -- but the latter category lists 13,228 donors to date out of a total of 95,136 for "all donor relations."

So, in fact, while there are many directed donations, plenty are also like "donating into commodity bank, like you do with plasma or sperm."

I take it you've never watched ER. :-)

I wouldn't take that risk for a thing, like a car, but I might take it to make sure my kids can get out of college without debt: I would be donating to my kids despite the fact that the kidney is going to some rich guy.

I also might take the risk to donate a kidney so I will be higher on the list for the inevitable liver I am likely to need.

russell: The sports car wouldn't be my own idea. I don't even drive. :o) But otherwise... if you think that, trust you, no one but those really up against it financial are going to want a lump sum of $50,000-$100,000, you must truly be horrified by this.

As to the rest:

You say simply "You got that right" about abhorrence or repugnance, and say of my comments about it that we are likely to disagree then. For what it's worth, I'll try explaining why I would be horrified to find myself giving similar assent and trust to my own repugnance or lack of it:

Opposition to gays and to gay rights has largely been based on exactly that, to assuming that one's own visceral reactions are reliable about how other people should be and how other people should feel.

From my sense of you, I'll guess that you'd support gays and gay rights. If you do, but you give this total assent to the place of visceral reactions, what can I think but that you are extending your LACK of a visceral reaction to say how other people should be and feel. While finding the gut-reactions you do have meaningful when you do have them. Your gut rules justice either way.

And, around us, other people are doing the same thing, on all sorts of things - to the tune of much heedless injustice, which is exactly what own-gut-dominance lends itself to.

I have no way of arguing with an authoritative disgust-reaction, but I can say a few things:

My own support for gays and gay rights, and for some other things as well, has come from the idea that what what I find repugnant, or not repugnant, is my business and must be treated as such, and what other people find repugnant, or not repugnant, is their business and must be treated as such, and that breaches of this general rule amount to unjust and destructive impositions.

I also think that, if I am going to help anyone, that I should not help them in my opinion at the expense of their opinion, unless I am going to stop calling what I am doing to them helping.

One thing you should note on this question: When you make the frame "I have a bigger problem with people selling body parts to survive, because then you are definitely into exploitation-land"... note that, in the case you just mention, they were doing it to survive - and you are taking that option away.

I agree with a second bit: "And for the record, the "screwed up" part here is the fact that people find themselves in the position where selling pieces of themselves is their best available choice. Nobody should have to find themselves in that position." And in the next post you say, "If you find yourself in a position of undergoing major surgery and removal of a vital organ because it is, frex, the only way to keep from losing your house, I'd say we're all f**ked." Poverty and tight-corner circumstances are the screwed-up part here, the coercive part. You're angry at that. Address that! Definitely, absolutely do. Gary mentioned supporting a negative income tax option, or do it however you choose. Reduce the tight corners. But to stop someone from rescuing themselves in the meantime because you find the way icky and inhuman, because it's "f**ked" and "no one should have to"? What happens then? To them? (And don't say that that's not your problem when your idea is to intervene.)

On the other hand, if you were really just on "whatever floats your boat," we'd have no disagreement.

In the meantime, yes, poverty, and sparseness of options, is what's f**ked.

"Blood, sperm, eggs, other parts for sale just seems profoundly problematic to me, on its face.

Just my two cents."

Egg donorship involves minor surgery, so that seems to me a bit different than donating blood, which although needles squick some people profoundly, still seems trivial to me. And sperm donation doesn't typically, according to majority practice, as I understand it, involve pain.

I'm really not clear what you find problematic about these things.

I do think there's obvious a scale -- of which our own personal scales vary -- of things we find problematic for one reason or another, and I certainly agree with you that there are things people shouldn't have to do in order to economically survive and provide for basic needs, including organ donation, and prostitution.

On the other hand, we can include on the scale, but distinctly upwards on it, having to take a really sh*tty job, instead of a more preferable one. Or having to only afford a really crap place to live, as opposed to a slightly nicer one. Etc.

So it does seem to me -- and I'm doubtless stating the banally obvious here -- that what's problematic isn't a binary thing so much as a scalar thing. Or maybe choices can be divided into those two categories, with the latter then being subdividable.

But my own opinion is that the essential problem is society not providing certain minimal necessities of life for everyone who can't provide for themselves. Specifically: shelter, minimal food, and medical care, if people are unable to provide for themselves.

Once those are taken care of, I'm inclined to let people make what arrangements they want, as innumerable exchanges in a capitalistic system are classifiable, to one degree or another, as "exploitive," and I don't see any sort of universally agreed-upon objective scale for that.

Alex -

I see where you're coming from with the repugnance issue.

The thing I find repugnant is not surgery, or the "icky" aspect of it. I have, in fact, been an organ donor myself, albeit at a very, very low risk level (bone marrow, for a family member).

What I find repugnant is the idea that people will be placed in the position of selling off their own damned vital organs in order to secure their basic needs.

And to further clarify, I don't find those people personally repugnant, what I find repugnant, or abhorrent, or what have you, is a cultural climate in which selling your vital organs is seen as simply another species of commercial transaction.

I got something you want (a kidney), you got something I want (money), let's deal.

To me, personally, that seems brutal and mercenary. Obscenely so.

It's like we've replaced "Are there no workhouses?" with "Don't you have a spare organ or two?"

In short, the fact that we're discussing a commercial market in personal bodily organs should be a great, big, fat red flag to all of us that something has gone awry.

We really, really should be able to find better ways to help and care for each other.

I take your point that "I think that's icky" is not a useful or sufficient basis for objecting to things that other people want or need to do. I hope my explanation here makes my meaning more clear.

Gary, thanks for the information about the organ banks.

But to stop someone from rescuing themselves in the meantime because you find the way icky and inhuman, because it's "f**ked" and "no one should have to"? What happens then? To them?

I think russell clarified the "icky" thing. That aside, don't we stop people from "rescuing" themselves all the time? I think the point is that the short-term rescue is, in the long run, worse than what someone may be trying to save themselves from. In any given case, we can argue about the means of rescue versus the immediate peril, which is fine. But to suggest that people shouldn't be stopped from doing whatever they might think it takes to get through a financial or other hardship doesn't seem consistent with being civilized. This line of thinking would justify all manner of exploitation, unless I'm missing something.

Any of you fellas want to touch this rebuttal?

"I think the point is that the short-term rescue is, in the long run, worse than what someone may be trying to save themselves from. In any given case, we can argue about the means of rescue versus the immediate peril, which is fine."

Ok, but again the long term risks appear to be vanishingly small to non existant. So you aren't trying to save them from an in-the-long-run.

Is anyone else willing to precommit to the level of immediate surgical risk that would make it ok?

Ok, but again the long term risks appear to be vanishingly small to non existant. So you aren't trying to save them from an in-the-long-run.

That's disputable, but I'm not necessarily trying to dispute it. Again, I'm just trying to clarify what the argument is. Simply saying that we shouldn't be keeping people from rescuing themselves as a general statement fails if the rescue is worse than the peril (and given the many uncontroversial restrictions of this general nature that have been placed on individuals by law for some time).

hairshirthedonist: Saying that Sebastian's comment about long term risks is disputable is - well, can you find evidence that contradicts the citations he's found suggesting that long-term risks are very low? (We can call anything in here "disputable" if we still wish to dispute it. It's too loose. The research might show that it is hard to dispute.)

But you were trying to clarify the general argument, in any case. Two questions about your comment, that sort of interrelate:

1. Well, what counts as "the rescue is worse than the peril"? Surely Sebastian's comments about long-term and short-term risks would be relevant to the judgment about selling a kidney. Why would selling a kidney be worse than the financial need, if it were worse? (One thing I would not want, or could not follow you in, is if "worse than the peril" remained unspecified, or in any sense, including anyone's unspecified sense that it ought to be worse.)

2. (might be a way to answer #1): There is a lot of specific kinds of "worse" or reasons for "worse". So, specific cases that you think fit this: Which kinds of "rescue worse than the peril" situations, presently restricted by law or not, would you compare selling one kidney to? Which kinds of such situations would you not compare it to? (Not all of them would be uncontroversial, necessarily.)

Left general, the general statement that "some rescues are worse than the peril", or that some options are banned for that reason, may be true but is not yet useful. (I didn't even include the question, "in whose opinion.")

Sebastian: I like the focus on making personal risk cutoffs explicit. But embarrassingly I cannot follow you as far as a number. Because, thinking about it, I could come up with a risk that would be too much for me - but I cannot come up with a risk that would be the right answer for an unspecified person different from me. Other people are more (or much more) or less (or much less) willing to take risks than I am. Any answer I came up with - that would be intended to be authoritative as far as I am concerned! it would be intended to control when to ban something for everyone - might as well have come out of a Ouija board. And I don't have any faith in Ouija boards.

The one thing I can say with certainty is that I do accept that people can take risks if they judge those risk worth it. So, the closest I can get to an answer is not about the level of riskiness. It is an insistence that, if doctors or people involved misrepresented the riskiness to a prospect for the operation, or failed to adequately advise the prospect of the risks, they would be laying themself open to massive civil liability. (... Which would probably be the case already.)

"Any of you fellas want to touch this rebuttal?"

Sure.

Distributed republic is quite right. Wal-mart is not actually going around and deliberately impoverishing people in order to coerce them into selling their fingers.

Noted.

It's just a crappy world when people have to sell their bodily organs to get by.

You don't think so? I'll give you $500 right now for the last two joints of your left pinky. What the hell do you need your left pinky for?

$500 ain't nothing, dude. I'll wire you the $$$ via PayPal, you'll have the money in about one New York minute.

Do we have a deal?

The topic of the thread is "why kidney selling bothers me". My answer has nothing to do with macoeconomics, libertarian purism, or any of that crap.

The reason it bothers me is that it's a sh*tty world when people have to sell off parts of their own bodies to get by.

And there's no freaking reason why the world has to be that sh*tty.

We spend just short of $20B a year on pet food in this damned country, and people should have to sell their own kidneys to make their way?

How f**ked up is that? Seriously, how f**ked up is that? Have we all gone out of our freaking minds?

Consider the rebuttal touched.

Over to you.

"Any of you fellas want to touch this rebuttal?"

A couple of bits: "But Wal-Mart doesn't make people poor*."

No, they don't, and obviously they don't make their employees poor: they make them wealthier than they would be without their voluntarily sought after and taken jobs.

But Wal-Mart does do its best to break and keep out unions, which they've done quite successfully in this country, and if they didn't make that choice, their employees would be less poor. Neither is this a case of having to do it; see a comparison between the choices Wal-Mart makes in employee treatment and benefits, and what Costco does.

So, no, I certainly wouldn't characterize Wal-Mart as using force, but I would characterize them as being less beneficial corporate citizens to their employees than they could be, and in my opinion, should be.

[...] Premise: It's terrible that some people are so poor that they might decide that selling a kidney is their best option.

Conclusion: Therefore we must make sure that they don't have that option.

That's certainly not the consensus the discussion overall has come up with.
[...] A somewhat less insane conclusion to draw from the premise is that we should find some way to raise the standard of living of the poor so that selling a kidney becomes a less attractive option**.
Now, that's something we have a consensus upon. But let's conveniently ignore what the discussion has actually produced, and liberals actually think, in favor of denouncing straw liberals, shall we?

And it saves so much reading time to just ignore what people have written.

But, wait, you say, Brandon Berg is only responding to publius' post, and not to the rest of the discussion!

Except, fail, because what publius actually wrote was:

[...] At the end of the day, I’m not sure any of this is helpful. I’ve basically said “there should be a line,” but I haven’t established whether kidney selling crosses that line.
So let's ignore publius, too, in favor of made-up straw liberals. They're so much easier to argue with. So much for "a fairly solid rebuttal" to any of the actual discussion here, or to what publius wrote.

"Saying that Sebastian's comment about long term risks is disputable is - well, can you find evidence that contradicts the citations he's found suggesting that long-term risks are very low?"

I'm a little tired of posting links about iatrogenetic risks, and the numbers, myself.

"And I don't have any faith in Ouija boards."

That's only because you haven't consulted one to ask about how much faith you should place in one.

Russell:

[...] I'll wire you the $$$ via PayPal, you'll have the money in about one New York minute.

Do we have a deal?

If you make it $5000, I'll start thinking seriously. Though I doubt I'd let it go for less than $10k, and I'd definitely start with a much higher offer, and haggle down, and see where we end up.

My opener is that for $100k, we absolutely have a deal. And I'm rather fond of my pinky, even though I don't even have a ring for it.

I suppose I'd just have to find another way to pick my nose. Or pick my toes in Poughkeepsie.

"Saying that Sebastian's comment about long term risks is disputable is - well, can you find evidence that contradicts the citations he's found suggesting that long-term risks are very low?"

I'm a little tired of posting links about iatrogenetic risks, and the numbers, myself.

Gary - You have indeed been posting links about iatrogenic risks. Those I classed, and I think Sebastian has too, as short-term risks. Sebastian has posted research about long-term risks of having only one kidney. That's what I was talking about, and what I presume hairshirthedonist meant by long-term risks.

"I'm a little tired of posting links about iatrogenetic risks, and the numbers, myself."

We've been trying to talk about the short term risks but no one else on the anti-kidney-sale side seems interested in engaging, and all you are doing is linking, so what would you like?

(Reckon I'll take a break. I'm starting to have loopy thoughts about whether I get to eat anyone's liver yet.)

with fava beans and a nice chianti? :)

...what I presume hairshirthedonist meant by long-term risks.

I considered a follow-up to eliminate the short-term/long-term distinction. It really doesn't matter. What does is "which is worse overall?"

And to follow up, Alex Russell, on your August 05, 2009 at 04:43 PM comment, what I was responding to was what I took to be your application of a general principle illustrated by:

But to stop someone from rescuing themselves in the meantime because you find the way icky and inhuman, because it's "f**ked" and "no one should have to"? What happens then? To them?

But now I think you were writing specifically about the case at hand (kidney sales) and simply doing so in general terms, not applying a general principle to the specific case of kidney sales. So I don't disagree with too much of your response, at least not enough that I want to bother getting into detail about it.

I'm more ambivalent about this issue than I was when this thread started, and most of my later comments regard the nature of the arguments being made rather than trying to make an argument in favor of a particular conclusion. It seems I've gotten a few resposes to my comments as though they were otherwise.

Incidentally, russell seems to have moved to another mode of discussing this issue that regards a larger concern for where we are as a society or perhaps as a species. I don't know what that says about a ban on kidney sales, since it would seem to be a Titanic-meets-deck chairs scenario, if I'm understanding him correctly.


"Gary - You have indeed been posting links about iatrogenic risks. Those I classed, and I think Sebastian has too, as short-term risks"

Okay. Myself, I figure that when:

In the United States, from 120,000 to 225,000 deaths per year may be attributed in some part to iatrogenesis.

[...]

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.

I figured that being dead counts as a pretty longterm risk, but I'm not going to quibble about categories here, so long as we've acknowledged the factor.]

And as a reminder to anyone who hasn't religiously read this entire thread, I'm not opposed to sales of kidneys, though I do lean more towards favoring a third party intercessor than towards direct sales; but mostly since I'm not forced to have an opinion, I don't have a strong opinion, and I definitely haven't come out against allowing either kind of sales/compensation, myself.

I merely thought that Sebastian was tending to brush by iatrogenetic factors when he keeps referring to the "low risk"involved.

I have nothing else to add or argue for now. Amazing, isn't that? :-)

Russell, I enjoy some nice chicken livers with onions, well salted and peppered, on occasion, myself. With or without chianti.

The greatest long-term risk to having a single kidney is suffering an injury that damages or destroys the kidney, but would have left the other kidney intact if you still had it. The upside to having a single kidney is that you might have to suffer through passing only half as many kidney stones.

I figured that being dead counts as a pretty longterm risk, but I'm not going to quibble about categories here, so long as we've acknowledged the factor.

I see. One of those miscommunications. Like having talk of a high risk in die-rolling turn out to be referring to the "6" being a high number.
If I may, then - suggested use: "Short-term" risk" here refers to risk of bad outcomes in the short term upon/after surgery, while "long-term" risk refers to the risk of bad effects years or decades later.
I suggest that "risk" refers to possibility/probability/chance of a bad outcome, rather than to a bad outcome itself.
A possible outcome of death, though death does last forever, is not therefore what is meant by "long-term risk."
At any rate, that is how I have been using vocabulary, and I believe Sebastian too. This may eliminate a (frustratingly mystifying up to now) logjam, maybe. So, now that it's clear we haven't been ignoring the information on iatrogenic risk/surgical error...?

"The upside to having a single kidney is that you might have to suffer through passing only half as many kidney stones."

Or undergo extracorporeal shock wave lithotripsy, which I can testify is no real big deal, aside from the novelty for men of dealing with the epidural, which is mostly just strange, rather than, in my experience,particularly unpleasant.

On the other hand, if you have to undergo invasive surgery to deal with your kidney stone, because it's too large and tough to be dealt with by extracorporeal lithotripsy, I can also testify that that's not so much fun.

So you can have six of one, or probably less than half a dozen of the other, but don't ask me which is which.

Oh, but also relevant if you have a kidney stone too large to pass, is having a renal stent inserted (fortunately, under general anesthesia); if you don't know what that is, or how it's done, don't ask, but I'm willing to assert that it's very very unpleasant to just live with. Especially if your kidney surgery gets repeatedly postponed for various reasons, such as overly high blood pressure, and being bumped by higher-level emergency surgery, and so forth.

Though you can get a nice supply of pain pills out of it, fwiw.

"If I may, then - suggested use: 'Short-term" risk' here refers to risk of bad outcomes in the short term upon/after surgery, while 'long-term' risk refers to the risk of bad effects years or decades later."

Fair enough.

I'd still note that iatrogenetic effects can include effects that don't manifest for many years, such as higher antibiotic resistance -- there are plenty of other iatrogenetic effects besides death -- but I do take your point, and won't quibble further about the usage of "risk."

Saying that Sebastian's comment about long term risks is disputable is - well, can you find evidence that contradicts the citations he's found suggesting that long-term risks are very low?

The assorted links posted by others upthread suggest that, absent proper medical care and/or a decent standard of living following donation, there are very real long-term risks in terms of decreased quality of life and health. Given that you specifically follow up the above comment with discussion of would-be donors being faced with a choice of kidney sale or grim financial need, I'm far from willing to take for granted that we should assume adequate health care (and convalescence) would be available to all paid donors. Barring assumptions to that effect, I'm really not sure why we should take a study suggesting no long-term ill effects from having a kidney extracted* from voluntary donors as being conclusive evidence that there are no long-term risks for paid donors.


*One interesting bit of trivia I stumbled across is that around one in 750 people, predominately males, are born with only one kidney. Excepting the fact that single-kidney failure would require transplant or suchlike, they're supposedly no worse off healthwise than renal redundants. This adds weight to the suggestion that long term risks would most likely arise from the surgery and aftercare, not from having only one kidney.

I think it would be clearer to discuss risks arising from having only one kidney vs. risks arising from having a kidney surgically extracted instead of the vague usage we've seen here with "long term vs. short term". FWIW.

No fellas - this argument by Brandon in particular:

"If the poor are to remain at their current standard of living, they're made better off by being given the option to sell their kidneys. If we do find some way to mitigate poverty further than we already have, the poor are still made better off by being given that option. And it's very unlikely that legalizing kidney sales will prevent further attempts at poverty mitigation."

It would be nice to read some argument beyond "it's a sh*tty world when people have to sell off parts of their own bodies to get by." Any argument that would make someone see how the poor are worse off by giving them more options rather than less?

The assorted links posted by others upthread suggest that, absent proper medical care and/or a decent standard of living following donation, there are very real long-term risks in terms of decreased quality of life and health.

Which "assorted" links are you referring to that make this particular point? It's been a very long thread. :o)

Given that you specifically follow up the above comment with discussion of would-be donors being faced with a choice of kidney sale or grim financial need, I'm far from willing to take for granted that we should assume adequate health care (and convalescence) would be available to all paid donors.

Well, depending on where you look otherwise, I've also suggested that a lot of people, maybe most people, who did this would not be facing grim financial need at all. And I think I've also mentioned that I support universal health care, a single payer system or basic health care safety-net in one form or another. Regardless, the case of a very poor seller is certainly part of the picture - and, regardless of whether we specially focus on this case or not, I could see requirements that adequate convalescence arrangements be part of the deal. Certainly such lousy arrangements as you mention are possible. The question then is, therefore... what? The question of how you weigh the question of these risks is still there.

I think it would be clearer to discuss risks arising from having only one kidney vs. risks arising from having a kidney surgically extracted instead of the vague usage we've seen here with "long term vs. short term". FWIW.

Fair enough. Less brief, but it seems it might have saved some trouble.

"If the poor are to remain at their current standard of living, they're made better off by being given the option to sell their kidneys. If we do find some way to mitigate poverty further than we already have, the poor are still made better off by being given that option. And it's very unlikely that legalizing kidney sales will prevent further attempts at poverty mitigation."

Much of the discussion here is about the ways poor people (or anyone else, possibly) would not be better off with that option. You might disagree with that discussion, but it's certainly there. Read some more. It shouldn't be hard to find. The reason the poor in particular are mentioned is that poor people would be far more likely to make the decision to sell their kidneys out of desperation and, therefore, in an ill-advised manner. For some, it would probably work out just fine. For others, not. But it's a lot easier to exploit desperate poor people by waving money at them than others. Maybe you're cool with that, and maybe you aren't. Finding new ways to make poverty suck might not be high on people's lists of things to do.

It would be nice to read some argument beyond "it's a sh*tty world when people have to sell off parts of their own bodies to get by." Any argument that would make someone see how the poor are worse off by giving them more options rather than less?

Mostly, see above. Otherwise, the "it's a sh*tty world" thing doesn't necessarily have to apply just to the poor, btw. It can also be a statement about people of any stripe selling their organs for money, if that makes any difference. Some people just think the whole deal is perverse.

I've pretty much given up on making arguments on the subject, so I'm just pointing out what kind of arguments are being made, since you seem to be looking for them, mr. pencil.

"No fellas [...]"

"It would be nice to read some argument beyond 'it's a sh*tty world when people have to sell off parts of their own bodies to get by.' Any argument that would make someone see how the poor are worse off by giving them more options rather than less?"

No, yourself, fella: first, you answer this question, please: have you bothered to read all the previous comments in this thread?

If so, your question has been answered. And you know that.

If not, why are you asking a question when you haven't bothered to read the many many answers? Why is Brandon refuting claims not made in the post he's allegedly responding to? Why is Brandon "refuting" a discussion he clearly hasn't bothered to read?

We've already gone first, second, third, and a few hundred times more. Your turn, now.

"it would seem to be a Titanic-meets-deck chairs scenario, if I'm understanding him correctly."

You read me aright.

"It would be nice to read some argument beyond "it's a sh*tty world when people have to sell off parts of their own bodies to get by." Any argument that would make someone see how the poor are worse off by giving them more options rather than less?"

Let's bring back indentured servitude. Screw that, let's let people sell themselves into chattel slavery.

Why stop at a kidney, let me buy your whole damned ass.

Why not?

You tell me why the poor are better off by having the option of selling themselves into slavery denied to them.

Who are we to deny them that choice? It's their life, isn't it?

Go ahead and riddle me that, and I'll be happy to continue a discussion of whether folks selling their vital organs is a splendid idea or not.

And for the record, at no point whatsoever have I said that selling organs should be outlawed. The original question on the table is "Why kidney selling bothers me".

I think I've made my answer to that question clear.

I wonder if after a couple of decades of folks selling their kidneys on the open market, we would have a whole lot of less-well-off people with one kidney and a whole bunch of bond traders, highly paid atheletes, celebrities, and John Boehner with three kidneys.

I think it's more likely we'd see a John Kidney with three boehners.

Ba-da-dum-da!

Gary's joke makes me wonder what is the difference between arguing that poor people should be able to sell their kidneys and that prostitution should be legalized? Is it that getting dialysis is a lot worse than not getting sex?

LJ,

I think more people would support legal prostitution than legal body part shops. Though I could be wrong. Maybe that is because the oldest tradition is clearly here to stay, while true human meat markets are pretty new.

I start from a position that assumes prohibition creates black markets, massive price increases, and then crime to pay for the product...followed by organized crime to victimize everyone.

I think the difference is scale: Kidney transplants will never be as lucrative as prostitution. Prostitution is therefore more of a threat of creating a destablizing black market.

So,, If I had to choose, I would legalize prostitution before legalizing kidney markets. Black market sex causes more problems than black market organs.

Thanks, and I should have laid out my thoughts rather than just toss that out there. My own feeling is that both are powerful opportunities for exploitation, which makes them both problematic. I understand that the way prostitution is controlled often criminalizes precisely the person who is being exploited, but making the sale of kidneys illegal does precisely the same thing. I would be hesitant to accept an argument that because women are more likely to have problems with poverty, they should be allowed to sell their bodies, and that seems like a mirror of the argument that the poor should be given a chance to profit from their kidneys.

A look-the-other-way attitude at some U.S. hospitals may be fostering a black-market trade in kidneys, transplant experts say.

Some hospitals do not inquire very deeply into the source of the organs they transplant because such operations can be highly lucrative, according to some insiders. A single operation can bring in tens of thousands of dollars for a hospital and its doctors.

Despite guidelines from various groups and Medicare, U.S. transplant centers are mostly free to write their own rules for screening donors to make sure they aren't selling their organs. The questions they ask vary widely. Some hospitals require long waiting periods to weed out shady donors; others don't.

"Some have a pretty cursory examination, like, 'Are you sure you want to do this?' " said Art Caplan, a University of Pennsylvania medical ethicist involved in a U.N. task force on international organ trafficking. "Some don't look very hard."
[...]

Lax hospitals may be fostering kidney-selling

I said it already on page 1: An important question about both prostitution and selling of body parts is, whether the right to do it can be construed as an obligation in certain circumstances including poverty. And as I have said, there was an actual debate in the German parliament, whether unemployment offices could offer women jobs at brothels (including as prostitutes, not just as waitresses etc.) and cut unemployment benfits in case of refusal*. The letter of the law would have allowed that. In a more narrow reading it would even have mandated it. The implementaion rules had to be amended to prevent that. If body parts could be qualified as 'assets' then the same could apply there. Thus it is not a merely academic question.

*Prostitution became officially legal at about the same time that the unemployment benefit rules were tightened.

Let's bring back indentured servitude. Screw that, let's let people sell themselves into chattel slavery. Why stop at a kidney, let me buy your whole damned ass.

1. This sort of behavior certainly sounds abhorrent. Still, on what ethical basis would any of us feel justified in legally restricting two consenting adults from entering into a contract with one another? You've said yourself that "at no point whatsoever have I said that selling organs should be outlawed". What of this?

2. I'm not sure this option is as far removed from the mainstream as you think. When you enlist in the military you do their bidding within the rules of their law; which does include severe penalties for going AWOL, desertion or insubordination to a superior. This is not so structurally different than entering into a servitude contract where similar infringements on your liberties are also agreed upon by both parties in advance.

And for the record, at no point whatsoever have I said that selling organs should be outlawed. The original question on the table is "Why kidney selling bothers me"

At the head of this entry I read:

The real challenge then, as John Schwenkler notes, is to justify the ban on kidney selling. So I’ll try.

The rest of the entry is an argument attempting to justify an actual ban.

"I start from a position that assumes prohibition creates black markets, massive price increases, and then crime to pay for the product...followed by organized crime to victimize everyone."

Actually, you start a little further back from that. You start from an assumption that a market in human organs should exist in the first place.

"This sort of behavior certainly sounds abhorrent. Still, on what ethical basis would any of us feel justified in legally restricting two consenting adults from entering into a contract with one another?"

The "ethical basis" would be the "abhorrent" part.

Per Alex Russell, not "abhorrent" in the sense of "icky" or "I don't like it" or "it makes me feel all squirmy". "Abhorrent" in the sense of "inherently lending itself to exploitation". Abhorrent in the same way that letting people sell themselves into chattel slavery would be abhorrent.

I think it's pretty obvious that most people will not sell their own organs for money unless they're fairly desparate. I doubt many, or any, folks here would sign up for it. To me, it's pretty f**king clear that having to sell your own organs to get by is pretty degrading.

The analogy to prostitution is, IMO, not far off. Do you all know anyone who's had to turn tricks in order to get by? How'd they feel about it?

"Preserving the option" for poor people -- people who, in our culture, are therefore without power or advantage of any kind -- to sell pieces of their own bodies in order to make it is a pretty f**king perverse way to help them out. It's not a form of "freedom" that anyone should have to endure.

The world of human relationships cannot and ought not be reduced to economic transactions. People aren't meat.

It's freaking astounding to me that this even needs to be argued, but since nobody else seems to be taking it up, I don't mind doing so.

As far as I'm concerned, "It's a f**ked up world when people have to sell their own vital organs to get buy" is a complete, sufficient, and persuasive reason not to do it. Because it sucks to live in a f**ked up world. We shouldn't allow each other to do so if it can be prevented, and in fact it can be prevented.

If you're intensely concerned about the folks who need the organs, which would be both fine and laudable, sign an organ donor card. If we all did it, the whole discussion would be moot.

"The rest of the entry is an argument attempting to justify an actual ban."

Fine. Sign me up for a ban.

It should be against the law for people to sell their own vital organs for money.

People who solicit organs for money should get 20 years, no parole. Their personal wealth should be liquidated, lock stock and barrel, and given to the folks whose organs they purchased. The donors should be punished not at all.

That's my take on it.

When you enlist in the military you do their bidding within the rules of their law; which does include severe penalties for going AWOL, desertion or insubordination to a superior. This is not so structurally different than entering into a servitude contract where similar infringements on your liberties are also agreed upon by both parties in advance.

Maybe not structurally different, but so what? They're different in that one can be justified for maintaining military order necessary for defending the country and the other can't.

There seems to be a tendency among self-described libertarians to overlook obvious practical concerns when it helps support their idealistic or ideological preferences. The world becomes a big abstraction where people and their sufferring don't matter in the face of Wonderful Abstract Libertarian Principles.

This sort of behavior certainly sounds abhorrent. Still, on what ethical basis would any of us feel justified in legally restricting two consenting adults from entering into a contract with one another?

The Right to Private Contract gets trotted out to justify all manner of ugliness. Contracts aren't simply useful in a great many endeavors; they are part of the fabric of the universe. And, really, who are we, mere humans, to form governments that might limit the Wonders of the Contract, to supress nature, itself? These mere concerns for the well-being of our fellow man cannot stand in the face of the All-Mighty Contract!

You know, it was all so obvious all along. Why didn't anyone consider that selling your kidney was a type of Contract? It's okay! It's a Contract! ...See?

(I apologize for my tone. I used to be one of those guys, so it annoys me tremendously.)

russell - Actually we are meat. Or we are souls that live in meat, depending. And some of us could use meat organ transplants. And some can provide them, or not.

Slavery is the permanent loss and subjection of a person's will and freedom and rights and destiny to another person. To sell a kidney for money that one receives for one's own reasons is not, because a whole human body and a kidney happen to be made of meat, a fraction of that loss of rights and own life; it is exactly none of that, just as to sell one's hair or plasma is not a more infinitesimal fraction of that, it is none of that. The objectionability of slavery and the reason why slavery is intolerable is because of the nature of slavery, of a person's right to his or her own life - not because of an intolerability of the idea of meat sales.

"If we all had organ donor cards this question would be moot" - not quite, even under that assumption, if someone needs a kidney sooner than we happen to die. And to simply retire to that is to retire to an imaginary world, as far as kidney supply, and say that organs ought to be available without this and you cannot be made to leave on this matter if it would mean tolerating something horrifying. Not to the people who do it. To you.

Actually I have known three people who have been prostitutes. One still does it.

I couldn't disagree more with this post, and the apex of the disagreement is that someone is said to now deserve twenty years without parole and the total forfeiture of his or her property because he or she has grievously offended your sense of rightness - because "it sucks to live in a f**ked up world." John Stuart Mill said something about this notion of "social rights". Let me answer, with equal fire behind it: For offending "the way the world should be", in my feeling or yours - and not having hurt anyone or violated anyone's rights - purely for outraging me or you - a person deserves not. One. Day. In. Jail.

If you're intensely concerned about the folks who need the organs, which would be both fine and laudable, sign an organ donor card. If we all did it, the whole discussion would be moot.

"The rest of the entry is an argument attempting to justify an actual ban."

Fine. Sign me up for a ban."

I'll just add: me, too. I would be significantly happier with a law that required organ donor participation with the only exclusion being religious reasons. At the least it should be the default with the ability to opt out rather than the requirement to opt in.

hairshirthedonist - I'm not a libertarian making that sort of worship of Contract about kidney sales, myself, and it doesn't have to boil down to that question. For me the crux of the question centers around the fact that this involves a short-term risk of surgical/post-surgical problems but then apparently little or no drawbacks for having done it. Surely, in my view, that - whether the activity is actually bad for you, or is actually destructive to one's interests if one engages in it, and how much it is - is the defining thing as to whether the activity should be called exploitative or exploitation. Begging the question of that, and saying it's supposedly a matter of worship of almighty Contract excusing exploitation, seems to me to tack away from the center question, which I don't think is really branded.

Marty - I would also support the opt-out requirement or the mandatory organ donation on death absent religious objections. Note that I can imagine this being the case simultaneously with the question of kidney sales.

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