When is forced organ selfishness good for you?

Simon Rippon claims having a market for organs might harm society:

It might first be thought that it can never be a good thing for you to have fewer rather than more options. But I believe that this attitude is mistaken on a number of grounds. For one, consider that others hold you accountable for not making the choices that are necessary in order to fulfil your obligations. As things stand, even if you had no possessions to sell and could not find a job, nobody could criticize you for failing to sell an organ to meet your rent. If a free market in body parts were permitted and became widespread, they would become economic resources like any other, in the context of the market. Selling your organs would become something that is simply expected of you when the financial need arises. A new “option” can thus easily be transformed into an obligation, and it can drastically change the attitudes that it is appropriate for others to adopt towards you in a particular context.

He’s right that at that moment where you would normally throw your hands in the air and move on, you are worse off if an organ market gives you the option of paying more debts before declaring your bankruptcy. But this is true for anything you can sell. Do we happen to have just the right number of salable possessions? By Simon’s argument people should benefit from bans on selling all sorts of things. For instance labor. People (the poor especially) are constantly forced to sell their time – such an integral part of their selves – to pay rent, and other debts they had no choice but to induce. If only they were protected from this huge obligation that we laughably call an ‘option’. Such a ban might be costly for the landlord, but it would be good for the poor people, right? No! The landlords would react and not rent to them.

So why shouldn’t we expect the opposite effect if people are allowed to sell more of their possessions? People who currently don’t have the assets or secure income to be trusted with loans or ongoing rental payments might be legitimately offered such things if they had another asset to sell. Think of all the people who would benefit from being able to mortgage their kidney to buy a car instead of riding to some closer job while they gradually save up.

In general when negotiating, it’s best to not have options that are worse for you. When the time comes to carry out your side of a deal, it’s true this means being forced to renege. But when making the deal beforehand, you do better to have the option of carrying out your part later, so that the other person does their part. And in a many shot game, you do best to be able to do your part the whole time, so the trading (which is better than not trading) continues.

21 responses to “When is forced organ selfishness good for you?

  1. So in a world with organ selling…
    – the poorest will be worse off because they’ll be missing organs
    – the poorish will be better off because they’ll have negotiating power

    And Katja thinks this turns out to be a good tradeoff.

  2. This question would be basically moot if we relinquished the idea that a corpse is spiritually significant. Just allow hospitals to take the organs of people who die within them (or within their care), with or without consent.

    You might as well legalise selling organs to save some red tape, but that should bring the supply of organs almost up to demand level, so the value of any such sale would probably be too low to worry anyone.

  3. By Simon’s argument people should benefit from bans on selling all sorts of things. For instance labor. People (the poor especially) are constantly forced to sell their time – such an integral part of their selves – to pay rent, and other debts they had no choice but to induce.

    Well, there are minimum wage laws, and restrictions on how many hours someone can work in a week…

  4. Given that losing one’s kidney is not a very big cost to the seller even if they don’t benefit from the money (http://www.nlm.nih.gov/medlineplus/news/fullstory_96189.html) and a huge benefit to the recipient (who doesn’t die), it’s not clear why the issue Simon raises should be a major concern.

    Funny to me that Sasha finds theft of someone’s body (not letting them do what they want with it in their will) to be simpler than just buying it. Do we only avoid theft in general because it saves paperwork?

  5. Rob, it seems like you’re resorting to prejudicial language in lieu of argument. Libertarians love to point out that the state already condones various forms of property redistribution, which most of us don’t fundamentally object to if we think it better serves the common interest than the alternative.

    In this case at the cost of a few offended family members you could save 4 (going with the original argument’s number) lives – and grant a huge boon to the saveees’ friends and families.

    Re your strange idea of theft, why does the notion apply here? We’re generally considered by law to own our bodies, not to have borrowed them from our family, so why does that suddenly change when we cease to exist?

    It would be more coherent to see the body as reverting to a public domain good, much as intellectual property used to on death, or as simply being a resource for the taking. Either way, the hospitals get to play with it. And if you don’t like the terms, you could not go to a hospital.

  6. Another option that might be more palatable in the short term is an opt-out donation system akin to Spain’s, but more reciprocal. Families wouldn’t be able to veto the process, and no-one who’d chosen to opt out would be eligible to receive organs.

  7. The different between selling “time” and other possessions versus selling organs is that organs are not as easily replaced.

    • How is time replaced? The whole point of selling organs is to replace them, so presumably they can be.

      • Time can’t be replaced, but it’s used up whether you have anything to do with it or not.

        Organs, on the other hand, while they can be transplanted, can’t be replaced. A ‘replacement’ organ has a significantly reduced useful lifespan compared to an original, and comes with a requirement of immune suppression that substantially increases your risk of dangerous diseases. A kidney is not a carburetor.

        • Most people can find something worthwhile to do with most of their time – do you disagree there is an opportunity cost to spending 8hrs a day at work?

          Even if organs can’t be built from scratch, we do have many more than we need. And compare immune suppression to the alternative.

  8. Even if you only value experiences not preference satisfaction (which could be achieved after death), people who really don’t want their organs taken and used would suffer knowing they will be compulsorily acquired after their death once your system is in place. For some religious groups it could be very unpleasant.

    If that were the only option I would put it on the table, but opt-out or voluntary sale are viable and get around the problem completely. Under those systems those who lose least/gain most from giving up their organs will provide them. A typical case of choice beating compulsion.

    Agree family shouldn’t have veto – they should persuade the person not to donate during their life if they feel strongly about it.

    “Re your strange idea of theft, why does the notion apply here? We’re generally considered by law to own our bodies, not to have borrowed them from our family, so why does that suddenly change when we cease to exist?”

    Taking someone’s stuff after their death and not following what their will requests is theft in my book. I think it serves the community well for people being able to pass most of their belongings onto whoever they choose on their death.

    • I’ll try and break up your points, Rob:
      “Even if you only value experiences not preference satisfaction (which could be achieved after death)”
      It requires bizarre metaphysics to have value conditional on non-conscious states of affairs. While I’m sympathetic to the kind of PU that emphasises the sensation of knowingly having a preference satisfied, it loses all credibility in the form required to make death special.
      “people who really don’t want their organs taken and used would suffer knowing they will be compulsorily acquired after their death once your system is in place.”
      We have a pretty strong legal and social prohibition against people using their religious beliefs to justify suffering – we don’t privilege honour killings, for example, and I think ‘hate crimes’, motivated by racial prejudice are punishable more harshly than equivalent acts of violence.
      I don’t particularly condone the current setup, but I don’t think you can appeal to it to justify religious privilege. If you want to find a difference, between this and such cases it would be in the indirectness of the harm caused by the religious beliefs, not the suffering of the religious. But that’s hardly a utilitarian view, and one that’s not even all that intuitive when you think that someone could well be dying within 50 metres of the corpse for want of an organ from it.
      “If that were the only option I would put it on the table, but opt-out or voluntary sale are viable and get around the problem completely.”
      No they don’t. Spain has the opt-out system, and still has a shortfall of organs. Refusing transplants to those who’ve opted out (and perhaps refusing the option to opt out after you’ve accepted a transplant) might go some way to solving the issue. I don’t think it’s ever been tried, so I don’t know how you’d find relevant data. Realistically that seems like a good goal to aim for in the short term. In the long term we’ll hopefully be able to grow organs quite cheaply anyway, so hopefully this will all be moot soon.
      Voluntary sale’s problems don’t go away just because people can decide not to sell. It seems unlikely that organs will both be expensive enough to encourage enough sales and cheap enough that they’re as widely available as they would be under the other schemes – it would be very surprising not to see a shortfall, conceivably a worse one than we have now. As the original quote implies, laws don’t exist in a vacuum. If you give people an option to do one thing, other laws will gradually adjust around them in response. Allowing the poor to sell their organs (without any process that devalues them) would put pressure on the welfare system to reduce the benefits they offer to organ-hoarding scroungers.
      I know what you think of the welfare system, but you know what I think of confident pronouncements of what effects interrelated economic policies will and won’t cause :) – so let’s not pretend voluntary sale is risk-free, or even low-risk.
      “A typical case of choice beating compulsion.”
      This sort of rhetoric makes me suspect you’re fundamentally libertarian with a few utilitarian ideas rather than the other way around. It’s literally (I mean literally literally :P) nonsense – everything comes with consequences you could describe as either choices and compulsions, and there’s no significant distinction between them, so it’s just a meaningless statement. I’m proposing giving doctors the ‘choice’ to use a lump of meat (that voluntarily placed itself in their care) as they see fit, you seem to propose compelling them not to. I propose compelling the family to give up their corpse, you propose giving them the choice not to. Effecting either path requires some sort of compulsion on and by the police. Can you explain to me how we weigh and quantify ‘choice’ in such a way as to show that one path has more than the other?
      In principle I want to adjust my views slightly towards organ-selling for the fact that a couple of intelligent economists support it, but when in practice they try to persuade with linguistic flourishes rather than statistical reasoning, it a) fails to give me any reason to and b) offers more evidence for my suspicion that macroeconomics is ultimately one of the humanities.

      • “It requires bizarre metaphysics to have value conditional on non-conscious states of affairs.”

        Bizarre to you but in fact most people have such a metaphysic. I’m a moral anti-realist as you know, so I’m not going to waste my time debating arbitrary preferences.

        “We have a pretty strong legal and social prohibition against people using their religious beliefs to justify suffering”

        Suffering is suffering, whatever the reason. Obviously I don’t think they’re actually going to hell so I’m not worried about that, but the suffering they feel during life is as valid a policy concern for a utilitarian as any other (at least if they can’t be persuaded to give up their religion). If it can be avoided it should be.

        There are also useful social outcomes from allowing people in general to live by their own religious rules ‘in the privacy of their own home’ as long as they do not disturb others. As long as they are free, they are less motivated to take over society as a whole, and there is less effort wasted on conflict over which religion the law should endorse and which is should disallow.

        “Spain has the opt-out system, and still has a shortfall of organs.”

        Wow – three and a half times our donation rate and they still have a shortfall! OK, opt-out *and* sales.

        “It seems unlikely that organs will both be expensive enough to encourage enough sales and cheap enough that they’re as widely available as they would be under the other schemes”

        Organ transplants would in western countries be cheaper than what the government pays for now: dialysis (for any reasonable kidney price). Get the govt to pay for it and everyone is better off.

        “I know what you think of the welfare system”

        I love it as a very efficient alternative to command and control anti-poverty policies? Yay Denmark.

        “Can you explain to me how we weigh and quantify ‘choice’ in such a way as to show that one path has more than the other?”

        Let both sides voluntarily exchange so that they’re both better off. Compel neither to do anything.

        The problem with forcing people to do anything, rather than using price signal as motivations until they want to do something, is that you get no feedback as to whether what you are doing is welfare enhancing or not, or the best way of doing something or a very poor one. Under a system of compulsory acquisition you might take a kidney from a family that will suffer immensely from the knowledge the organs are taken, when if prices were involved you would have just gone down the corridor to take an organ from someone whose family doesn’t mind at all (which would be much cheaper/have a lower reserve price if the dead person cared about their family).

        That said, it’s true that if the doctor’s inherit the organs on the person’s death and then offer to sell them back to the family (and not remove the) an efficient allocation of resources is still reached (Coase’ Theorem). Seems needlessly complicated though.

        “a) fails to give me any reason to”

        But you’ve already accepted it’s better…

        “b) offers more evidence for my suspicion that macroeconomics is ultimately one of the humanities.”

        This is very standard microeconomics, not macro at all.

        We don’t always have to limit ourselves to Pareto improvement – sometimes we have to go further as utilitarans. But we should use Pareto improvements where they are possible, as here.

        • “Suffering is suffering, whatever the reason. Obviously I don’t think they’re actually going to hell so I’m not worried about that, but the suffering they feel during life is as valid a policy concern for a utilitarian as any other (at least if they can’t be persuaded to give up their religion). If it can be avoided it should be.”

          Yes, but moral offense is not a source of great suffering, nor nearly as persistent across generations as that which inequality generates. Why are you so confident that this form of suffering is greater than that of a poor person pressured into selling his organs? It seems very likely to be the other way around to me, and my way saves more lives.

          “Wow – three and a half times our donation rate and they still have a shortfall! OK, opt-out *and* sales.”

          This is one of the options I’ve been advocating… It leaves open the question of how to combine the two, though – if you’re not encouraging people to agree to have their organs removed while they still live, what’s the disincentive to them for opting out and then selling back in?

          “Organ transplants would in western countries be cheaper than what the government pays for now: dialysis (for any reasonable kidney price). Get the govt to pay for it and everyone is better off.”

          Not sure exactly what you have in mind here. Not so much a market as an incentive scheme? What would the government buy?

          “I love it as a very efficient alternative to command and control anti-poverty policies? Yay Denmark.”

          Ok, I don’t know what you think of it :P (who are you, and what have you done with Rob?)

          “Let both sides voluntarily exchange so that they’re both better off. Compel neither to do anything.”

          Not a good enough answer to satisfy me. You’ve synonymed ‘choice’ as ‘letting’, and haven’t done anything at all about compulsion. Both are still enormously vague concepts, and for any rigorous definition you give of them I’d bet money now that I can show that either of our suggestions involves both choice and compulsion.

          “The problem with forcing people to do anything, rather than using price signal as motivations until they want to do something, is that you get no feedback as to whether what you are doing is welfare enhancing or not, or the best way of doing something or a very poor one.”

          This reminds me of the argument that the universe is so complex it requires an even more complex creator. Price signals don’t obviously solve the choice at all – you’ve just deferred the problem by adding another layer to it. Obviously in some cases money spent corresponds closely to honest evaluation and in others it doesn’t – how do we tell which is which without resorting to the sort of research that you’re suggesting the market does away with a need for?

          “This is very standard microeconomics, not macro at all.”

          I thought micro was applied mathematics? I don’t see any mathematics anywhere on this page…

          “Take a microeconomics101 course and what I’m saying will seem much clearer. Without supply and demand curves (or utility curves if you like) dancing in your head this isn’t so clear.”

          I would love to, but they’re not exactly cheap to stroll into.

          Generally though, the line ‘take an (x)101 course and you’ll be told why I’m right’ seems pretty weak. Pretty much any pseudo-intellectual drivel has a ‘pseudo-intellectual drivel 101’ course somewhere if you look hard enough (cough: http://www.amazon.com/Intelligent-Design-101-Leading-Experts/dp/0825427819) – notwithstanding my prior belief that microecon has something going for it, what evidence can you actually offer that it does?

          “There is a reason there is so much overlap between microeconomists and utilitarianians; microeconomics is a sort of applied utilitarianism and you just can’t go without it.”

          I’m entirely convinced that economics should play a very large part in any kind of utilitarian thinking. I’m far less convinced that many economists practice the subject.

  9. Arg, excuse the formatting. That’s what comes of writing in Word.

    I forgot to mention another option – grow unconscious lab babies and take their organs once they’re developed. It’ll offend at least as many people as my first suggestion, but none of them will be able to lay claim to any kind of ownership of the body in question. It seems likely to cost much more than just taking organs that’ve been pre-grown, though.

  10. Take a microeconomics101 course and what I’m saying will seem much clearer. Without supply and demand curves (or utility curves if you like) dancing in your head this isn’t so clear.

    There is a reason there is so much overlap between microeconomists and utilitarianians; microeconomics is a sort of applied utilitarianism and you just can’t go without it.

  11. Katya: I will confess up front that I had trouble following your response to the Rippon quote, except that you seem to be in favor of more choice and autonomy as a general rule, and are seeking to establish a policy heuristic unencumbered by moral judgment about the particular thing being chosen.

    Organ donation is a complicated issue that tries to balance competing priorities, and I don’t pretend to have a strong opinion about it. But let’s consider the case of work requirements in the context of public assistance, say, or Chapter 13 bankruptcy.

    Let’s say the earning potential of a welfare applicant is being evaluated. (I’m not sure how this process works in real life, but let’s imagine a policy that makes welfare benefits contingent on showing a willingness to work in the most remunerative capacity available. I would, in general, be in favor of such a policy; my tax dollars, after all, shouldn’t subsidize the life of someone who freely chooses to just sit around or “work” doing something for which there is low market demand.)

    What if the case worker said to her, well, you seem like an attractive young woman. You could make plenty of money as a prostitute.

    Obviously, there is only one acceptable answer to the suggestion that the applicant should be required by the welfare department to work as a hooker. But I’m not sure how you can get there without reference to the legal and moral norms regarding the sex trade. The effect of these norms is to reduce the sphere of choice available to the applicant and case-worker alike. But how else can we avoid an untenable position?

    • I didn’t say I favored more choice as a rule, and I thought I spoke in detail about the nature of the thing being chosen – it seems to me others want to establish a policy heuristic based only on their own emotional reactions, without looking at the structure of what they are judging, in particular how it interacts with anything else.

      Do you think welfare recipients should have to sell all of their unneccesarry possessions before they recieve money from the public purse? Or work in jobs that they are personally unsuited to due to injury or psychological problems? Welfare doesn’t require prostitution because most people would prefer to offer help before it comes to that, similarly for other unsuitable jobs and unneccesary possessions and presumably organ sales, were they legal. But I’m not discussing when the public should be happy to pay for people – obviously that’s a matter of the public’s morals etc.

  12. You are almost certainly correct on your first point, although we should realize that “emotional reaction” is not how many people would characterize what they see as their moral intuition.

    I suppose my honest answer to your questions about welfare is, “It depends.” But I wasn’t really trying to steer the conversation toward welfare except to point out that the same public morals that forbid us to require the “poor” to sell their bodies are also reflected in the laws forbidding such sale anyway, prostitution and organ sales being broadly forbidden.

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