Contention 1 – organ sales will save lives
The ban on organ sales for transplant has created a large and growing shortage
Williams 14 Kristy L. Williams, University of Houston Law Center, Health Law & Policy Institute;
University of Texas Medical Branch, Institute of Medical Humanities.; Marisa Finley, Baylor Scott &
White Health Center for Health Care Policy; J. James Rohack, Baylor Scott & White Health March 31,
2014 American Journal of Law and Medicine, Forthcoming Just Say No to NOTA: Why the Prohibition
of Compensation for Human Transplant Organs in NOTA Should Be Repealed and a Regulated Market for
Cadaver
Organs Instituted
http://ssrn.com/abstract=2418514
Organ transplantation saves thousands of lives every year. However, many individuals die
waiting for transplants due to an insufficiency of organs.1 Currently, more than 122,000
individuals are waitlisted for organs in the United States.2 Due to financial and other barriers to
becoming waitlisted, the actual number of Americans requiring organs is likely higher.3 This gap
between available organs and the need for organs continues to widen.4 The supply of organs is
limited as only a small number of individuals die in circumstances medically eligible for
organ donation, and less than sixty-eight percent of eligible individuals donate.5 As a result of those long waitlists and limited
supply there is a substantial need to increase organ donations. This paper will focus on increasing consent rates for cadaveric organ
donation in the Unites States by repealing current law prohibiting cadaveric donors and their estates from being financially compensated.6
The current organ donation system in the United States relies on the altruism of donors. The
National Organ Transplantation Act (NOTA) prohibits the receipt of any form of valuable consideration in
exchange for organs to be used for transplantation.7 State statutes also prohibit the sale of certain organs and
tissue for transplantation; however, state laws vary widely as to what body parts are covered.8 As paying for organs is prohibited, other
methods have been employed in attempts to increase donations.9 Despite the implementation
of these strategies, a severe organ shortage remains.
Varied efforts to increase voluntary donations fail – individually and in combination
Beard 8 T.RANDOLPH BEARD, JOHN D. JACKSON , AND DAVID L. KASERMAN, profs of economics,
Auburn University
Winter 2008 Regulation
The Failure of US 'Organ Procurement Policy
http://object.cato.org/sites/cato.org/files/serials/files/regulation/2007/12/v30n4-3.pdf
Aware of the increasingly dire consequences of continued reliance on the existing approach to cadaveric organ procurement and alarmed
at the figures shown above, the
transplant industry has examined and adopted a series of policy
options ostensibly designed to improve the system’s performance. All of these, however,
continue to maintain the basic zero-price property of the altruistic system. As a result, the
likelihood that any of them, even in combination, will resolve the organ shortage is remote. At
least seven such actions have been implemented over the last two decades or so: ■ INCREASED
EDUCATIONAL EXPENDITURES In the absence of financial incentives, moral suasion becomes the principal avenue
through which additional supply may be motivated. Consequently, the organ procurement organizations (opos) created under the 1984 Act
have launched substantial promotional campaigns. The campaigns have been designed to both educate the general public about the
desperate need for donated organs and educate physicians and critical care hospital staff regarding the identification of potential deceased
donors. Over the years, a substantial sum has been spent on these types of educational activities. Recent empirical evidence, however,
suggests that further spending on these programs is unlikely to increase supply by a significant amount. ■ ORGAN DONOR CARDS A related
activity has been the process of incorporating organ donor cards on states’ driver licenses. The cards can be
easily completed and witnessed at the time the licenses are issued or renewed. They serve as a pre-mortem statement of the bearer’s wish
to have his or her organs removed for transplantation purposes at the time of death. Their principal use, in practice, is to facilitate the
opos’ efforts to convince surviving family members to consent to such removal by revealing the decedant’s wishes. The 1968 Uniform
Anatomical Gift Act gave all states the authority to issue donor cards and incorporate them in drivers’ licenses. Moreover, a few states have
recently begun to rely entirely on donor cards to infer consent without requiring the surviving family’s permission when such cards are
present. Survey evidence indicates that less than 40 percent of U.S. citizens have signed their donor cards. ■ REQUIRED REQUEST Some
survey evidence published in the late 1980s and early 1990s found that in a number of cases families of potential deceased donors were
not being asked to donate the organs. As a result, donation was apparently failing to occur in some of those instances simply because the
request was not being presented. In response to this evidence, federal
legislation was passed in 1987 requiring all
hospitals receiving any federal funding (which, of course, is virtually all hospitals) to request organ donation in all deaths
that occur under circumstances that would allow the deceased’s organs to be used in transplantation. It appears that this legal obligation is
now being met in most, if not all, cases. Yet, the organ shortage has persisted and the waiting list has continued to grow. ■ REQUIRED
REFERRAL While required-request legislation can compel hospitals to approach the families of recently deceased potential organ donors
with an appeal for donation, it cannot ensure that the request will be made in a sincere, compassionate manner likely to elicit an
agreement. Following implementation of the required-request law, there were a number of anecdotes in which the compulsory organ
donation requests were presented in an insincere or even offensive manner that was clearly intended to elicit a negative response. The
letter of the law was being met but not the spirit. As a result, additional
legislation was passed that requires hospitals to
refer potential organ donors to the regional opo so that trained procurement personnel can approach the surviving family
with the donation request. This policy response has resulted in no perceptible progress in resolving the shortage. ■ COLLABORATION A
fairly recent response to the organ shortage has been the so-called “Organ Donation Breakthrough Collaborative,”
which was championed by then-secretary of health and human services Tommy Thompson. The program was initiated shortly after
Thompson took office in 2001 and is currently continuing. The program’s basic motivation is provided by the observation of a considerable
degree of variation in performance across the existing opos. Specifically, the number of deceased organ donors per thousand hospital
deaths has been found to vary by a factor of almost five across the organizations. The presumption, then, is that the relatively successful
opos employ superior procurement techniques and/or knowledge that, if shared with the relatively unsuccessful organizations, would
significantly improve their performance. Thus, diffusion of “best practice” techniques is seen as a promising method through which
cadaveric donation rates may be greatly improved. A thorough and objective evaluation of the Thompson initiative has not, to our
knowledge, been conducted. Figure 1, in conjunction with a recent econometric study of observed variations in opo efficiency, suggests
that such an evaluation would yield both good news and bad news. The good news is that the program appears to have had a positive (and
potentially significant) impact on the number of donations. In particular, it appears that, after 2002, the growth rate of the waiting list has
slowed somewhat. Whether this effect will permanently lower the growth rate of the waiting list or simply cause a temporary intercept
shift remains to be seen. The bad news, however, is unequivocal— the initiative is not going to resolve the organ shortage. Even if, contrary
to reasonable expectations, all opo relative inefficiencies were miraculously eliminated (i.e., if al organizations’ performance were brought
up to the most efficient unit), the increase in donor collection rates would still be insufficient to eliminate the shortage. ■
KIDNEY
EXCHANGES Another approach that has received some attention recently involves the exchange of kidneys between families who
have willing but incompatible living donors. Suppose, for example, a person in one family needs a kidney transplant and a sibling has
offered to donate the needed organ. Further suppose that the two siblings are not compatible — perhaps their blood types differ. If this
family can locate a second, similarly situated family, then it may be possible that the donor in the first family will match the recipient in the
second, and vice versa. A relatively small number of such exchanges have recently occurred and a unos-based computerized system of
matching such interfamily donors has been proposed to facilitate a larger number of these living donor transactions. Two observations
regarding kidney exchanges are worth noting. First, such exchanges obviously constitute a crude type of market in living donor kidneys that
is based upon barter rather than currency. Like all such barter markets, this exchange will be considerably less efficient than currencybased trade. Puzzlingly, some of the staunchest critics of using financial incentives for cadaveric donors have openly supported expanded
use of living donor exchanges. Apparently, it is not market exchange per se that offends them but, rather, the use of money to facilitate
efficient market exchange. This combination of positions merely highlights the critics’ lack of knowledge regarding the operation of market
processes. It is quite apparent that living donor kidney exchanges are not going to resolve the organ shortage. Opportunities for such
barter-based exchanges are simply too limited. ■ REIMBURSEMENT OF DONOR COSTS Finally, in another effort to encourage an
increase in the number of living (primarily kidney) donors, several states have passed legislation
authorizing
reimbursement of any direct (explicit) costs incurred by such donors (e.g., travel expenses, lost wages, and so on).
Economically, this policy action raises the price paid to living kidney donors from a negative amount to zero. As such, it should be expected
to increase the quantity of organs supplied from this source. Because the explicit, out-of-pocket expenses associated with live kidney
donation are unlikely to be large relative to the longer-term implicit costs of potential health risks, however, such reimbursement should
not be expected to bring forth a flood of new donors. Moreover, recent empirical evidence suggests that an increase in the number of
living donors may have a negative impact on the number of deceased donors because of some degree of supply-side substitutability. Again,
this policy is not a solution to the organ shortage. We
must conclude that none of the above-listed policies should
be expected to resolve the transplant organ shortage. We say this not because we oppose any of these policies;
indeed, each appears sensible in its own right and some have unquestionably succeeded in raising the number of organ donors by some
(perhaps nontrivial) amount.
Rather, our concern is that every time another one of these marginalist policies
is devised, it delays the only real reform that is capable of fully resolving the organ shortage.
The shortage means many die
Beard 8 T.RANDOLPH BEARD, JOHN D. JACKSON , AND DAVID L. KASERMAN, profs of economics,
Auburn University
Winter 2008 Regulation
The Failure of US 'Organ Procurement Policy
http://object.cato.org/sites/cato.org/files/serials/files/regulation/2007/12/v30n4-3.pdf
WAITING LISTS YET TO COME The consequences of our
failure to adapt our cadaveric organ procurement policy to
that more
than 80,000 lives have now been sacrificed on the altar of our so-called “altruistic” system. In
addition, the unnecessary pain and suffering of those who have been forced to wait while
undergoing dialysis, unemployment, and declining health must also be reckoned along with
the growing despair of family members who must witness all of this. Nonetheless, the pain,
suffering, and death imposed on the innocents thus far pales in comparison to what lies
ahead if more fundamental change is not forthcoming. In order to illustrate the severe consequences of a
the changed technological realities of the transplant industry have been unconscionable. Figure 2, above, suggests
continuation of the altruistic system, we use the data presented in Figures 1 and 2 above to generate forecasts of future waiting lists and
deaths. The forecasts represent our best guess of what the future holds if fundamental change continues to be postponed. The results
should serve as a wake-up call for those who argue that we should continue tinkering with the existing procurement system while further
postponing the implementation of financial incentives. The costs of such a “wait and see” approach are rapidly becoming intolerable.
CHANGING VARIABLE To produce reasonable forecasts of future waiting lists and deaths, we must first confront an apparent anomaly in
the reported data that could cast doubt on the accuracy of some of the more recent figures. Specifically, the reported number of deaths of
patients on the waiting list (plus those too sick to receive a transplant) follows a consistently upward trend that is very close to a constant
proportion of the size of the waiting list over most of the sample period. Beginning in 2002, however, the number of deaths levels off and
even starts to decline, despite continued growth of the waiting list. It is not clear why there is an abrupt change in the observed trend in
this variable. Our investigation of this issue yielded several plausible explanations but no definitive answer. For example, it may be the case
that recent advances in medical care, such as the left ventricular assist device, have extended some patients’ lives and, thereby, reduced
the number of deaths on the list. Alternatively, it may be the case that because of rising criticism of the current system, unos has taken
steps to remove some of the relatively higher-risk patients from the list before they die. For example, the meld/peld program, which was
introduced in February 2002, removed a number of liver patients (who have a comparatively high death rate) from the waiting list.
Additionally, the increasing use of so-called “extended criteria” donor organs may have a similar effect, getting the most critically ill
patients off the list prior to their deaths. Clearly, the implications of these alternative explanations for reliance on the data are not the
same. For example, if patients are, in fact, simply living longer and the data accurately reflect that reality, then our analysis should
incorporate the observations. But if the more recent figures are, instead, a manifestation of strategic actions taken by the reporting
agency, then they should be excluded. Because we have been unable to identify a single, convincing explanation for the observed
phenomenon, we elected to perform our analysis both ways — including and excluding the post-2002 observations on the number of
deaths. ESTIMATES Given the two alternative sample periods, the methodology we employ to generate our forecasts is as follows: First,
because the number of deaths appears to be causally driven by the number of patients on the waiting list, we begin by estimating a simple
linear regression model of the former as a function of the latter. The results of that estimation are reported in Table 1 for the two sample
periods described above. Next, we estimate a second linear model with the number of patients on the waiting list regressed against time,
again using the two alternative sample periods. Those results are reported in Table 2. From the results, we
are able to produce
forecasts of the expected size of future waiting lists for each of our sample periods. We run the forecasts
out 10 years from the end of our longer sample period, to 2015. Given the forecasted waiting list values, we are then able to use the
regression results in Table 1 to generate our forecasts of the number of deaths over the same period. The two alternative sets of forecasts
are shown graphically in Figures 3 and 4. Depending upon the sample period chosen, the results show the waiting list reaching 145,691 to
152,400 patients by 2015. Of the patients listed at that time, between 10,547 and 13,642 are expected to die that year. Even more
tragically, over the entire period of both actual and predicted values, a
cumulative total of 196,310 patients are
conservatively expected to die by 2015 as a consequence of the ongoing shortage. Figure 5 illustrates
the results. In that figure, we incorporate several historical reference points in order to put the numbers in perspective. No one directly
involved in the transplant industry is likely to be surprised by our results. Thirty years of experience consistently point to a continuation of
the current, long-standing trends. There is nothing on the horizon that should lead anyone to expect a sudden reversal. But our purpose is
not to surprise the parties who are already knowledgeable about this increasingly severe problem. Rather, our intent is to awaken the
sleeping policymakers whose continuing inaction will inevitably lead to these results. They can no longer continue to postpone meaningful
reform of the U.S. organ transplant system in the futile hope that, somehow, things will improve. They will not.
Organ sales would be the most effective way to solve the transplant shortage
Study by Becker and Elias 14 Gary S. Becker, Nobel Prize-winning professor of economics at the
University of Chicago and a senior fellow at the Hoover Institution; and Julio J. Elias, economics
professor at the Universidad del CEMA in Argentina. Updated Jan. 18, 2014 Wall Street Journal Cash
for Kidneys: The Case for a Market for Organs
http://online.wsj.com/news/articles/SB10001424052702304149404579322560004817176?mod=WSJ_h
pp_MIDDLENexttoWhatsNewsFifth
Finding a way to increase the supply of organs would reduce wait times and deaths, and it
would greatly ease the suffering that many sick individuals now endure while they hope for a
transplant. The most effective change, we believe, would be to provide compensation to people
who give their organs—that is, we recommend establishing a market for organs. Organ transplants
are one of the extraordinary developments of modern science. They began in 1954 with a kidney transplant performed at Brigham &
Women's hospital in Boston. But the practice only took off in the 1970s with the development of immunosuppressive drugs that could
prevent the rejection of transplanted organs. Since then, the number of kidney and other organ transplants has grown rapidly, but not
nearly as rapidly as the growth in the number of people with defective organs who need transplants. The result has been longer and longer
delays to receive organs. Many of those waiting for kidneys are on dialysis, and life expectancy while on dialysis isn't long. For example,
people age 45 to 49 live, on average, eight additional years if they remain on dialysis, but they live an additional 23 years if they get a
kidney transplant. That is why in 2012, almost 4,500 persons died while waiting for kidney transplants. Although some of those waiting
would have died anyway, the great majority died because they were unable to replace their defective kidneys quickly enough. Enlarge
Image The toll on those waiting for kidneys and on their families is enormous, from both greatly reduced life expectancy and the many
hardships of being on dialysis. Most of those on dialysis cannot work, and the annual cost of dialysis averages about $80,000. The total cost
over the average 4.5-year waiting period before receiving a kidney transplant is $350,000, which is much larger than the $150,000 cost of
the transplant itself. Individuals can live a normal life with only one kidney, so about 34% of all kidneys used in transplants come from live
donors. The majority of transplant kidneys come from parents, children, siblings and other relatives of those who need transplants. The
rest come from individuals who want to help those in need of transplants. In recent years, kidney exchanges—in which pairs of living
would-be donors and recipients who prove incompatible look for another pair or pairs of donors and recipients who would be compatible
for transplants, cutting their wait time—have become more widespread. Although these exchanges have grown rapidly in the U.S. since
2005, they still account for only 9% of live donations and just 3% of all kidney donations, including after-death donations. The relatively
minor role of exchanges in total donations isn't an accident, because exchanges are really a form of barter, and barter is always an
inefficient way to arrange transactions. Exhortations and other efforts to encourage more organ donations have failed to significantly close
the large gap between supply and demand. For example, some countries use an implied consent approach, in which organs from cadavers
are assumed to be available for transplant unless, before death, individuals indicate that they don't want their organs to be used. (The U.S.
continues to use informed consent, requiring people to make an active declaration of their wish to donate.) In our own highly preliminary
study of a few countries—Argentina, Austria, Brazil, Chile and Denmark—that have made the shift to implied consent from informed
consent or vice versa, we found that the switch didn't lead to consistent changes in the number of transplant surgeries. Other studies have
found more positive effects from switching to implied consent, but none of the effects would be large enough to eliminate the sizable
shortfall in the supply of organs in the U.S. That shortfall isn't just an American problem. It exists in most other countries as well, even
when they use different methods to procure organs and have different cultures and traditions. Paying
donors for their
organs would finally eliminate the supply-demand gap. In particular, sufficient payment to kidney
donors would increase the supply of kidneys by a large percentage, without greatly increasing
the total cost of a kidney transplant. We have estimated how much individuals would need to
be paid for kidneys to be willing to sell them for transplants. These estimates take account of the slight risk to
donors from transplant surgery, the number of weeks of work lost during the surgery and recovery periods, and the small risk of reduction
in the quality of life. Our
conclusion is that a very large number of both live and cadaveric kidney
donations would be available by paying about $15,000 for each kidney. That estimate isn't exact, and
the true cost could be as high as $25,000 or as low as $5,000—but even the high estimate wouldn't increase the total cost of kidney
transplants by a large percentage. Few countries have ever allowed the open purchase and sale of organs, but Iran
permits the
sale of kidneys by living donors. Scattered and incomplete evidence from Iran indicates that the price of kidneys there is
about $4,000 and that waiting times to get kidneys have been largely eliminated. Since Iran's per capita income
is one-quarter of that of the U.S., this evidence supports our $15,000 estimate. Other countries are also starting to think along these lines:
Singapore and Australia have recently introduced limited payments to live donors that compensate mainly for time lost from work. Since
the number of kidneys available at a reasonable price would be far more than needed to close
the gap between the demand and supply of kidneys, there would no longer be any significant
waiting time to get a kidney transplant. The number of people on dialysis would decline
dramatically, and deaths due to long waits for a transplant would essentially disappear. Today,
finding a compatible kidney isn't easy. There are four basic blood types, and tissue matching is complex and involves the combination of six
proteins. Blood and tissue type determine the chance that a kidney will help a recipient in the long run. But the sale of organs would result
in a large supply of most kidney types, and with large numbers of kidneys available, transplant surgeries could be arranged to suit the
health of recipients (and donors) because surgeons would be confident that compatible kidneys would be available. The system that we're
proposing would include payment to individuals who agree that their organs can be used after they die. This is important because
transplants for heart and lungs and most liver transplants only use organs from the deceased. Under a new system, individuals would sell
their organs "forward" (that is, for future use), with payment going to their heirs after their organs are harvested. Relatives sometimes
refuse to have organs used even when a deceased family member has explicitly requested it, and they would be more inclined to honor
such wishes if they received substantial compensation for their assent. The idea of paying organ donors has met with strong opposition
from some (but not all) transplant surgeons and other doctors, as well as various academics, political leaders and others. Critics have
claimed that paying for organs would be ineffective, that payment would be immoral because it involves the sale of body parts and that the
main donors would be the desperate poor, who could come to regret their decision. In short, critics believe that monetary payments for
organs would be repugnant. But the
claim that payments would be ineffective in eliminating the
shortage of organs isn't consistent with what we know about the supply of other parts of the
body for medical use. For example, the U.S. allows market-determined payments to surrogate mothers—and surrogacy takes
time, involves great discomfort and is somewhat risky. Yet in the U.S., the average payment to a surrogate mother is only about $20,000.
Another illuminating example is the all-volunteer U.S. military. Critics once asserted that it wouldn't be possible to get enough capable
volunteers by offering them only reasonable pay, especially in wartime. But the all-volunteer force has worked well in the U.S., even during
wars, and the cost of these recruits hasn't been excessive. Whether paying donors is immoral because it involves the sale of organs is a
much more subjective matter, but we question this assertion, given the very serious problems with the present system. Any claim about
the supposed immorality of organ sales should be weighed against the morality of preventing thousands of deaths each year and improving
the quality of life of those waiting for organs. How can paying for organs to increase their supply be more immoral than the injustice of the
present system? Under the type of system we propose, safeguards could be created against impulsive behavior or exploitation. For
example, to reduce the likelihood of rash donations, a period of three months or longer could be required before someone would be
allowed to donate their kidneys or other organs. This would give donors a chance to re-evaluate their decisions, and they could change
their minds at any time before the surgery. They could also receive guidance from counselors on the wisdom of these decisions. Though
the poor would be more likely to sell their kidneys and other organs, they also suffer more than others from the current scarcity. Today,
the rich often don't wait as long as others for organs since some of them go to countries such as India, where they can arrange for
transplants in the underground medical sector, and others (such as the late Steve Jobs ) manage to jump the queue by having residence in
several states or other means. The sale of organs would make them more available to the poor, and Medicaid could help pay for the added
cost of transplant surgery. The altruistic giving of organs might decline with an open market, since the incentive to give organs to a relative,
friend or anyone else would be weaker when organs are readily available to buy. On the other hand, the altruistic giving of money to those
in need of organs could increase to help them pay for the cost of organ transplants. Paying
for organs would lead to more
transplants—and thereby, perhaps, to a large increase in the overall medical costs of transplantation. But it would save the cost
of dialysis for people waiting for kidney transplants and other costs to individuals waiting for
other organs. More important, it would prevent thousands of deaths and improve the quality
of life among those who now must wait years before getting the organs they need.
Contention 2 is illegal markets
The US ban on sales has created an international illegal market
Hughes 9 J. Andrew Hughes, J.D. candidate, Vanderbilt University Law School, May 2009.
Vanderbilt Journal of Transnational Law January, 2009 42 Vand. J. Transnat'l L. 351
Note: You Get What You Pay For?: Rethinking U.S. Organ Procurement Policy in Light of Foreign Models
U.S. organ procurement policy has consequences beyond a domestic organ shortage. A
thriving global black market in human organs has resulted from U.S. policy banning organ
sales. n78 While nearly all developed nations have banned the sale and purchase of human organs, many countries do not strictly
enforce these laws. n79 The illegality of the organ trade is insufficient to discourage many of those
faced with the possibility of dying on an organ waiting list, and "transplant tourism" has
become its own industry. n80 In Bombay in 2001, nearly US$ 10 million were exchanged for kidney transplants. n81 Patients
use kidney brokers to locate sellers, who circumvent a ban on kidney sales by signing an affidavit swearing that they are not being paid. n82
Before the U.S. invaded Iraq in 2003, that country was known as "one of [the] world's best black marketplaces for human organs." n83 The
lack of effective prosecution of these transactions extends beyond Asia and the Middle East to Europe, as recent cases in Estonia and
Germany suggest. n84 U.S.
doctors perform illegal transplants, too, often under hospitals' "don't ask,
don't tell" policy regarding transplants involving foreigners who claim to be related. n85 U.S.
hospitals set their own rules for who can be a live organ donor, and organ brokers can locate hospitals that do not question a purported
familial relationship between "donors" and "donees." n86 The
lack of a regulated organ marketplace in the U.S.
has resulted in exploitation of the poor throughout the world. n87 Organ sellers often face debt,
unemployment, and serious health problems; as such, they are easy targets for abuse. n88 Prisoners and the homeless are among those
exploited. n89 Sellers of organs on the black market are often paid less than what they were initially promised, while their financial
situations and health often grow worse after the transplants. n90 Data from the Indian black market trade in kidneys [*363] support the
concern about sellers' lack of adequate information about the risks involved. In one study, 86% of the sellers there reported that their
health had "deteriorated substantially" after their organ sales, and "four out of five sellers would not recommend that others follow their
lead in selling organs." n91 In
short, U.S. policy and its ban on organ sales have produced some of the
same immoral and unethical consequences the ban was designed to avoid. n92
Economically desperate people are coerced into selling their organs in the hope of
bettering their situation. As a result of the actions of unscrupulous organ brokers and
inadequate medical care, they are actually made worse off.
Jaycox 12 Michael P. Jaycox, teaching fellow and Ph.D. candidate in theological ethics at Boston
College,
COERCION, AUTONOMY, AND THE
PREFERENTIAL OPTION FOR THE POOR IN THE ETHICS OF ORGAN TRANSPLANTATION
Developing World Bioethics Volume 12 Number 3 2012 pp 135–147
http://onlinelibrary.wiley.com/doi/10.1111/j.1471-8847.2012.00327.x/pdf
Pakistani surgeon and bioethicist Farhat Moazam offers the results of a recent study in
which he interviewed thirty-two farm laborers in Pakistan, each of whom had sold a kidney within the past three years. 14 He
found that almost all of these organ vendors were in significant debt to wealthy landlords
at the time they sold their kidneys; the average debt of each was 130,000 rupees at the time of sale. Although
the vendors were promised by third-party brokers an average price of 160,000 rupees
per kidney, the amount actually received by the vendors was an average of 103,000
rupees. As a result, a majority (17) of them were ‘either still in debt or had accumulated
new debts’ at the time of their interviews. 15 Moreover, a majority of the vendors experienced longterm physical and psychological malady as a result of their nephrectomies, and a
majority also expressed regret or shame for their decision because they were not freed
from their debts and/or felt they had committed a morally wrong act. When asked why they had
made the decision, ‘the most common [Urdu] words they used were majboori (a word that arises from the root jabr, which means a
state that is beyond one’s control) and ghurbat (extreme poverty).’16,Moazam
summarizes his findings with the
conclusion that the sale of kidneys functions to reinforce the poverty of those who sell them:
In the words of the vendors, they sell a kidney...in order to fulfill what they see as obligations toward immediate and extended
families in which they are inextricably embedded, and within systems of social and economic inequalities which they can neither
control nor escape. They sell kidneys in hopes of paying off loans taken to cover their families’ medical expenses or to meet the
responsibilities for arranging marriages and burying their dead. These are recurring expenses, and for most the debts rapidly
accumulate again, even if they have been partially or completely paid back with the money from selling a kidney. 17 4 F. Moazam,
R.M. Zaman & A.M. Jafarey. Conversations with Kidney Vendors in Pakistan: An Ethnographic Study.Hastings Cent Rep 2009; 39: 29–
44. Due to recent legislation (18 March 2010), the sale of human organs is now illegal in Pakistan, although the social effects of this
new legislation remain to be studied; see T.M. Pope. Legal Briefing: Organ Donation and Allocation. J Clin Ethics 2010; 21: 243–263:
254.
For many, the coercion is more violent
Bowden 13 Jackie Bowden, 2013 J.D. graduate from St. Thomas University School of Law.
Intercultural Human Rights Law Review 2013 8 Intercultural Hum. Rts. L. Rev. 451 ARTICLE:
FEELING EMPTY? ORGAN TRAFFICKING & TRADE: THE BLACK MARKET FOR HUMAN ORGANS lexis
[*452] Introduction Organ trafficking has been depriving innocent people of their fundamental
right to life for decades. n1 Imagine living in a poor country, where you wake up in the morning and set out to
find work and food for the day. As you walk peacefully to your home at the end of the day, you are grabbed and
thrown into the back of an unmarked truck. n2 You wake up, screaming from excruciating pain, as a surgeon
slices through your flesh to remove your kidney. Due to the costs associated with such a procedure, no
anesthesia is administered and no medication is given to prevent infection. n3 In the event that the
surgery does not go as planned, no forms of emergency assistance are available. Your body is then dumped on a side
street, and you are extremely lucky if you live. Should you report the incident to government officials? What if the
government is actually involved in this inhumane activity? n4 [*453] There are conflicting views on whether people are actually kidnapped
for their organs. n5 In fact, many believe these stories are just myths. n6 However,
there are reported accounts
suggesting that abduction of organs is a harsh reality of organ trafficking. n7 Reports indicate organ
trafficking is so prevalent that there is a surplus of organs available for transplantation. n8 Furthermore, there is evidence
of governmental involvement, which contributes to and exacerbates the problem. n9 Fortunately,
most countries have enacted laws to prevent and prohibit organ trafficking from occurring. n10
trafficking for organs is widespread
Kendrick 12 The Kendrick Theme 2012 Organ Removal http://fightslaverynow.org/why-fightthere-are-27-million-reasons/otherformsoftrafficking/organ-removal/
Organ removal, while not as prevalent as sex and labor trafficking, is quite real and
widespread. Those targeted are sometimes killed or left for dead. More frequently poor and
desperate people are lured by false promises. The World Health Organization estimates that as many as 7,000 kidneys
are illegally obtained by traffickers every year as demand outstrips the supply of organs legally available for transplant. A black market
thrives as well in the trade of bones, blood and other body tissues. This activity is listed in the United Nations’ Trafficking in Persons
Protocol: Article 3(a)… Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual
exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs.
Victims of trafficking experience horrific forms of dehumanization- we must reject this
violence
Crouse ’07 (Janice, PhD, Senior Fellow at the Beverly LaHaye Institute, the think tank for Concerned
Women for America, “Sex Trafficking Victims: Disposable or Human”, July 12, 2007,
http://www.cwfa.org/articledisplay.asp?id=13418, [SG])
We have all heard the catchy song lyrics about "what happens in Mexico" staying in Mexico or the advertisements about "what happens in
Vegas" staying in Vegas. Ambassador Lagon addressed that fallacy. "What 'happens' in these places does not 'stay' in these
places. It is a stain on humanity. Every time a woman, a girl, a foreign migrant is treated as less than
human, the loss of dignity for one is a loss of dignity for us all." It was gratifying to hear the ambassador directly
address the problems of American popular culture in glamorizing the "ho" and "pimp." He said, "It's high time we treat pimps as
exploiters rather than hip urban rebels. When a pimp insists his name or symbol be tattooed on his 'girls'
he is branding them like cattle — dehumanizing them, treating them like property." There are those who would
argue that human trafficking is the inevitable outcome of poverty and that some poverty—stricken people choose willingly to be involved. But,
"There is a growing refusal to accept enslavement as an inevitable product of
poverty or human viciousness. Corruption is typically poverty's handmaiden in cases of human
trafficking." CWA is pleased to be among those that Ambassador Lagon called an "indomitable force." We and other evangelical Christians
as Ambassador Lagon pointed out,
are at the forefront of this battle as modern—day abolitionists who work for the human rights of women and for the dignity of all of God's
We agree with Ambassador Lagon that trafficking in persons "shouldn't be regulated or merely
mitigated; it must be abolished." The victims of this crime are among the "most degraded, most
exploited, and most dehumanized people in the world." We join the ambassador in declaring, "Exploiters must
be stigmatized, prosecuted, and squeezed out of existence." Those who treat people as commercial
commodities — pimps, madams and johns — are slavers who buy and sell human beings as disposable
goods for their brothels, factories or fields. We must work for good laws and good law enforcement that will treat human
people.
trafficking as a criminal offense that will be investigated and the perpetrators prosecuted, convicted and punished to the fullest extent of the
Otherwise, such crimes undermine everyone's liberty and freedom; only corruption—free
democratic processes create a society where peace and prosperity are possible for all citizens.
law.
Structural violence is the largest proximate cause of war- creates priming that
psychologically structures escalation
Scheper-Hughes and Bourgois ‘4
(Prof of Anthropology @ Cal-Berkely; Prof of Anthropology @ UPenn) (Nancy and Philippe, Introduction: Making Sense of Violence, in
Violence in War and Peace, pg. 19-22) **Answers no root cause- because there is no root cause we must be attentative to structural
inequality of all kinds because it primes people for broader violence- our impact is about the scale of violence and the disproportionate
relationship between that scale and warfare, not that one form of social exclusion comes first
This large and at first sight “messy” Part VII is central to this anthology’s thesis. It encompasses everything from the routinized,
bureaucratized, and utterly banal violence of children dying of hunger and maternal despair in Northeast Brazil (Scheper-Hughes,
Chapter 33) to elderly African Americans dying of heat stroke in Mayor Daly’s version of US apartheid in Chicago’s South Side
(Klinenberg, Chapter 38) to the racialized class hatred expressed by British Victorians in their olfactory disgust of the “smelly” working
classes (Orwell, Chapter 36). In these readings violence is located in the symbolic and social structures that overdetermine and allow the
criminalized drug addictions, interpersonal bloodshed, and racially patterned incarcerations that characterize the US “inner city” to be
normalized (Bourgois, Chapter 37 and Wacquant, Chapter 39). Violence also takes the form of class, racial, political self-hatred and
adolescent self-destruction (Quesada, Chapter 35), as well as of useless (i.e. preventable), rawly embodied physical suffering, and death
(Farmer, Chapter 34). Absolutely
central to our approach is a blurring of categories and
distinctions between wartime and peacetime violence. Close attention to the “little”
violences produced in the structures, habituses, and mentalites of everyday life shifts our
attention to pathologies of class, race, and gender inequalities. More important, it interrupts the
voyeuristic tendencies of “violence studies” that risk publicly humiliating the powerless who are often forced into complicity with social
and individual pathologies of power because suffering is often a solvent of human integrity and dignity. Thus, in this anthology we are
positing a violence continuum comprised of a multitude of “small wars and invisible genocides” (see also Scheper- Hughes 1996; 1997;
2000b) conducted in the normative social spaces of public schools, clinics, emergency rooms, hospital wards, nursing homes,
courtrooms, public registry offices, prisons, detention centers, and public morgues. The
violence continuum also refers
to the ease with which humans are capable of reducing the socially vulnerable into
expendable nonpersons and assuming the license - even the duty - to kill, maim, or soulmurder. We realize that in referring to a violence and a genocide continuum we are flying in the face of a tradition of genocide
studies that argues for the absolute uniqueness of the Jewish Holocaust and for vigilance with respect to restricted purist use of the term
genocide itself (see Kuper 1985; Chaulk 1999; Fein 1990; Chorbajian 1999). But we hold an opposing and alternative view that, to the
contrary, it
is absolutely necessary to make just such existential leaps in purposefully linking
violent acts in normal times to those of abnormal times. Hence the title of our volume: Violence in War and
in Peace. If (as we concede) there is a moral risk in overextending the concept of “genocide” into spaces and corners of everyday life
where we might not ordinarily think to find it (and there
is), an even greater risk lies in failing to sensitize
ourselves, in misrecognizing protogenocidal practices and sentiments daily enacted as
normative behavior by “ordinary” good-enough citizens. Peacetime crimes, such as prison
construction sold as economic development to impoverished communities in the mountains and deserts of California, or the evolution of
the criminal industrial complex into the latest peculiar institution for managing race relations in the United States (Waquant, Chapter
39), constitute
the “small wars and invisible genocides” to which we refer. This applies to African American
and Latino youth mortality statistics in Oakland, California, Baltimore, Washington DC, and New York City. These are
“invisible” genocides not because they are secreted away or hidden from view, but quite
the opposite. As Wittgenstein observed, the things that are hardest to perceive are those which are
right before our eyes and therefore taken for granted. In this regard, Bourdieu’s partial and unfinished theory
of violence (see Chapters 32 and 42) as well as his concept of misrecognition is crucial to our task. By including the normative everyday
forms of violence hidden in the minutiae of “normal” social practices - in the architecture of homes, in gender relations, in communal
work, in the exchange of gifts, and so forth - Bourdieu forces us to reconsider the broader meanings and status of violence, especially the
links between the violence of everyday life and explicit political terror and state repression, Similarly, Basaglia’s notion of “peacetime
crimes” - crimini di pace - imagines a direct relationship between wartime and peacetime violence. Peacetime
crimes
suggests the possibility that war crimes are merely ordinary, everyday crimes of public
consent applied systematically and dramatically in the extreme context of war. Consider the
parallel uses of rape during peacetime and wartime, or the family resemblances between the legalized violence of US immigration and
naturalization border raids on “illegal aliens” versus the US government- engineered genocide in 1938, known as the Cherokee “Trail of
Tears.” Peacetime crimes suggests that everyday forms of state violence make a certain kind of domestic peace possible. Internal
“stability” is purchased with the currency of peacetime crimes, many of which take the form of professionally applied “strangle-holds.”
Everyday forms of state violence during peacetime make a certain kind of domestic “peace” possible. It is an easy-to-identify peacetime
crime that is usually maintained as a public secret by the government and by a scared or apathetic populace. Most subtly, but no less
politically or structurally, the phenomenal growth in the United States of a new military, postindustrial prison industrial complex has
taken place in the absence of broad-based opposition, let alone collective acts of civil disobedience. The
public consensus is
based primarily on a new mobilization of an old fear of the mob, the mugger, the rapist, the
Black man, the undeserving poor. How many public executions of mentally deficient
prisoners in the United States are needed to make life feel more secure for the affluent? What
can it possibly mean when incarceration becomes the “normative” socializing experience for ethnic minority youth in a society, i.e., over
it is essential that we recognize the
existence of a genocidal capacity among otherwise good-enough humans and that we need
to exercise a defensive hypervigilance to the less dramatic, permitted, and even rewarded
everyday acts of violence that render participation in genocidal acts and policies possible
(under adverse political or economic conditions), perhaps more easily than we would like to recognize. Under the violence
continuum we include, therefore, all expressions of radical social exclusion,
33 percent of young African American men (Prison Watch 2002). In the end
dehumanization, depersonal- ization, pseudospeciation, and reification which normalize
atrocious behavior and violence toward others. A constant self-mobilization for alarm, a
state of constant hyperarousal is, perhaps, a reasonable response to Benjamin’s view of late
modern history as a chronic “state of emergency” (Taussig, Chapter 31). We are trying to recover here the
classic anagogic thinking that enabled Erving Goffman, Jules Henry, C. Wright Mills, and Franco Basaglia among other mid-twentiethcentury radically critical thinkers, to perceive the symbolic and structural relations, i.e., between inmates and patients, between
concentration camps, prisons, mental hospitals, nursing homes, and other “total institutions.” Making
that decisive move
to recognize the continuum of violence allows us to see the capacity and the willingness if not enthusiasm - of ordinary people, the practical technicians of the social consensus, to
enforce genocidal-like crimes against categories of rubbish people. There is no primary
impulse out of which mass violence and genocide are born, it is ingrained in the common
sense of everyday social life. The mad, the differently abled, the mentally vulnerable have
often fallen into this category of the unworthy living, as have the very old and infirm, the
sick-poor, and, of course, the despised racial, religious, sexual, and ethnic groups of the
moment. Erik Erikson referred to “pseudo- speciation” as the human tendency to classify some individuals or social groups as less
than fully human - a prerequisite to genocide and one that is carefully honed during the unremark- able peacetimes that precede the
sudden, “seemingly unintelligible” outbreaks of mass violence.
Collective denial and misrecognition are
prerequisites for mass violence and genocide. But so are formal bureaucratic structures and professional roles.
The practical technicians of everyday violence in the backlands of Northeast Brazil (Scheper-Hughes, Chapter 33), for example, include
the clinic doctors who prescribe powerful tranquilizers to fretful and frightfully hungry babies, the Catholic priests who celebrate the
death of “angel-babies,” and the municipal bureaucrats who dispense free baby coffins but no food to hungry families. Everyday
violence encompasses the implicit, legitimate, and routinized forms of violence inherent in
particular social, economic, and political formations. It is close to what Bourdieu (1977, 1996) means by
“symbolic violence,” the violence that is often “nus-recognized” for something else, usually something good. Everyday violence is
similar to what Taussig (1989) calls “terror as usual.” All these terms are meant to reveal a public secret - the hidden links between
violence in war and violence in peace, and between war crimes and “peace-time crimes.” Bourdieu (1977) finds domination and violence
in the least likely places - in courtship and marriage, in the exchange of gifts, in systems of classification, in style, art, and culinary tastethe various uses of culture. Violence, Bourdieu insists, is everywhere in social practice. It is misrecognized because its very
everydayness and its familiarity render it invisible. Lacan identifies “rneconnaissance” as the prerequisite of the social. The exploitation
of bachelor sons, robbing them of autonomy, independence, and progeny, within the structures of family farming in the European
countryside that Bourdieu escaped is a case in point (Bourdieu, Chapter 42; see also Scheper-Hughes, 2000b; Favret-Saada, 1989).
Following Gramsci, Foucault, Sartre, Arendt, and other modern theorists of power-vio- lence, Bourdieu treats direct aggression and
physical violence as a crude, uneconomical mode of domination; it is less efficient and, according to Arendt (1969), it is certainly less
legitimate. While power and symbolic domination are not to be equated with violence - and Arendt argues persuasively that violence is
to be understood as a failure of power - violence, as we are presenting it here, is more than simply the expression of illegitimate physical
force against a person or group of persons. Rather, we need to understand violence as encompassing all forms of “controlling processes”
(Nader 1997b) that assault basic human freedoms and individual or collective survival. Our task is to recognize these gray zones of
violence which are, by definition, not obvious. Once again, the point of bringing into the discourses on genocide everyday, normative
experiences of reification, depersonalization, institutional confinement, and acceptable death is to help answer the question: What makes
mass violence and genocide possible? In this volume we are suggesting that
mass violence is part of a continuum,
and that it is socially incremental and often experienced by perpetrators, collaborators,
bystanders - and even by victims themselves - as expected, routine, even justified. The
preparations for mass killing can be found in social sentiments and institutions from the family, to schools, churches, hospitals, and the
harbor the early “warning signs” (Charney 1991), the “priming” (as Hinton, ed., 2002 calls it), or the
“genocidal continuum” (as we call it) that push social consensus toward devaluing certain forms of
human life and lifeways from the refusal of social support and humane care to vulnerable “social parasites” (the nursing home
military. They
elderly, “welfare queens,” undocumented immigrants, drug addicts) to the militarization of everyday life (super-maximum-security
prisons, capital punishment; the technologies of heightened personal security, including the house gun and gated communities; and
reversed feelings of victimization).
The illegal market is also a threat to public health—spreads anti-biotic resistant
bacteria
Kelly 13 Emily Kelly, Executive Comment Editor for the Boston College International & Comparative
Law Review. Boston College International and Comparative Law Review Spring, 2013 36 B.C. Int'l &
Comp. L. Rev. 1317 NOTE: INTERNATIONAL ORGAN TRAFFICKING CRISIS: SOLUTIONS ADDRESSING THE
HEART OF THE MATTER lexis
[*1324] With regard to recipients, the dangers of receiving medical care in developing countries can outweigh the benefits of life-saving
transplant tourism. n66 Because
governmental disease control agencies do not monitor underground
organ trafficking, recipients risk contracting infectious diseases like West Nile Virus and HIV.
n67 Tragically, transplant tourists also have "a higher cumulative incidence of acute [organ] rejection in the first year after transplantation."
n68 Transplant tourism also harms global public health policies. n69 Most notably, the underground market
impedes the success of legal organ donation frameworks. n70 For example, Thai patients have difficulty accessing health care because local
doctors are preoccupied with the lucrative practice of treating transplant tourists. n71 In 2007, China banned transplant tourism because
wealthy foreigners--rather than the 1.5 million Chinese on the waiting list--received an overwhelming amount of organ transplants. n72
Grisly tales of transplant tourism and conspiracy theories surrounding organ theft may also discourage individuals from agreeing to
altruistic donation upon death out of fear that their bodies may be exploited. n73 This further contributes to the global organ shortage and
exacerbates the underlying causes of OTC trafficking. n74 Additionally,
transplant tourism and broader medical
tourism facilitate the spread of antibiotic-resistant bacteria. n75 Because such bacteria are
frequently found in hospitals, tourists are easily exposed and transmit these unique strains
across borders upon returning to their home countries. n76 As a result of these effects, transplant tourism has
drawn increasing attention to the root of the problem: organ shortages. n77
antibiotic-resistance risks extinction
MacKenzie 13 Debora MacKenzie 13 March 2013 New Scientist Antibiotic resistance an
'apocalyptic threat' http://www.newscientist.com/article/mg21729084.000-antibiotic-resistance-anapocalyptic-threat.html
ANTIBIOTIC resistance poses an "apocalyptic" threat to human health. We are facing
"nightmare bacteria" and are losing a "war" against them. Such language, in statements made over the past week by the top UK
and US medical authorities – normally a very cautious breed – reflects the enormity of the situation they feel we must now confront. In
fact, our
predicament is even worse than these words suggest, with antibiotic-resistant bacteria
out of control in some areas. What's more, New Scientist can reveal that effective new drugs may already exist – but are
stuck in the final stages of development because they cannot overcome economic and regulatory hurdles.
Increasing reliance on the illegal market means the threat is serious—specifically causes
tropical disease
Franco-Paredes 10 Carlos Franco-Paredes, Jesse T. Jacob. Alicia Hidrona, Alfonso J. RodriguezMorales,David Kuhara, and Angela M. Caliendoa all with Division of Infectious Diseases, Emory
University School of Medicine except Redriguez-Morales at Division of Immunoparasitology, Tropical
Medicine Institute, Universidad Central de Venezuela International Journal of Infectious Diseases
Volume 14, Issue 3, March 2010, Pages e189–e196 Transplantation and tropical infectious diseases
http://www.sciencedirect.com/science/article/pii/S1201971209002045
More transplantation procedures are being performed annually, resulting in an increase in
the number of immunocompromised hosts.1, 2, 3, 4, 5, 6 and 7 Most of the literature in infectious diseases in
transplantation has focused on common pathogens prevalent in industrialized Western countries, where most transplantation surgeries
occur.1, 2, 4, 5, 6 and 7 However, in
the last decade, there has been a growing identification of tropical
infectious diseases occurring in transplant hosts in endemic and non-endemic settings.3, 4, 7, 8,
9, 10 and 11 The epidemiologic reasons for the growing number of reports of tropical infections
appearing in transplant recipients include: (1) increasing travel of transplanted patients to the tropics and
subtropics;8, 12 and 13 (2) increasing population immigration from endemic areas for tropical infections to non-endemic settings;6, 14 and
15 (3) increasing
numbers of transplantation procedures taking place in tropical countries;11, 16,
17, 18 and 19 and (4) many individuals traveling overseas for ‘transplant tourism’ in countries with
high prevalence of tropical infectious diseases.20 and 21 In general, transmission of these infections occurs through
three main routes: donor-derived infections,3, 4, 6, 15 and 22 reactivation or recrudescence of latent infections,16, 22, 23 and 24 or
transmission de novo during the post-transplant period.4 and 16 Infectious pathogens may be carried by the graft or the infection may be
acquired through transfusion of blood products during or after the transplantation.3, 4
Tropical disease are uniquely likely to spread globally—they’re resistant to
immunization
Franca et al. 13 (R. Franca, Department of Pharmacology, School of Medicine of Ribeirao Preto,
University of Sao Paulo, Brazil, C. C. de Silva, Department of General Biology, Federal University of
Vicosa, Brazil, S.O. De Paula, Laboratory of Molecular Immunovirology, Federal University of Vicosa,
Brazil, “Recent Advances in Molecular Medicine Techniques for the Diagnosis, Prevention, and Control of
Infectious Diseases,” Springer-Verlag Berlin Heidelberg, submitted November 26, 2012, published
January 22, 2013, pg. 1)
Abstract In recent years we have observed great advances in our ability to combat infectious diseases. Through the development of novel
genetic methodologies, including a better understanding of pathogen biology, pathogenic mechanisms, advances in vaccine development,
designing new therapeutic drugs, and optimization of diagnostic tools, significant infectious diseases are now better controlled. Here, we briefly
describe recent reports in the literature concentrating on infectious disease control. The focus of this review is to describe the molecular
methods widely used in the diagnosis, prevention, and control of infectious diseases with regard to the innovation of molecular techniques.
Since the list of pathogenic microorganisms is extensive, we emphasize some of the major human infectious diseases
(AIDS, tuberculosis, malaria, rotavirus, herpes virus, viral hepatitis, and dengue fever). As a consequence of these developments, infectious
diseases will be more accurately and effectively treated; safe and effective vaccines are being developed and rapid detection of infectious
agents now permits countermeasures to avoid potential outbreaks and epidemics. But, despite
considerable progress,
infectious diseases remain a strong challenge to human survival. Introduction Despite the great
advances in medicine, particularly in new therapeutic drugs, diagnostic tools, and even ways to
prevent diseases, the human species still faces serious health problems. Among these problems,
those that draw the most attention are infectious diseases, especially in poor regions. An
important feature of infectious disease is its potential to arise globally, as exemplified by known
devastating past and present pandemics such as the bubonic–pneumonic plague, Spanish flu
(1918 influenza pandemic), and the present pandemic of human immunodeficiency virus (HIV),
in which an estimated 33.3 million persons were living with the HIV infection worldwide at the end of 2009 [1–3]. In addition, other nonviral diseases are significant public health problems, as exemplified by tuberculosis (TB). This
infectious disease accounts for one third of the world’s bacterial infections (TB infected), and in 2010 a total of 8.8 million people worldwide
became sick with TB [1, 4]. In
recent years, new forms of infectious diseases have become significantly
important to medical and scientific communities; these forms are now widely known as emergent and reemergent infectious diseases. With the appearance of new transmissible diseases, such as SARS,
West Nile and H5N1/H1N1 Influenza viruses, in addition to reemerging diseases like dengue fever, the concerns
about a global epidemic are not unfounded [5]. Moreover, in the tropical and subtropical
regions of the world, parasitic infections are a common cause of death. Since one of the
major characteristics of infectious diseases is its inter-individual transmission, advances in personal protection, effective public policy, and
immunological procedures are efficient means of controlling the spread of these diseases. Thus, improvement of pre-existing technologies
commonly used to monitor, prevent, and treat infectious
community, but also to
diseases is of crucial importance not only to the medical
humankind.
Infectious disease spread causes extinction
Darling 12 (David, Astronomer, “9 Strange Ways the World Really Might End”, Seattle's Big Blog, 3-18,
http://blog.seattlepi.com/thebigblog/2012/03/18/9-strange-ways-the-world-really-mightend/?fb_xd_fragment, Washington State University)
Our body is in constant competition with a dizzying array of viruses, bacteria, and parasites, many
of which treat us simply as a source of food or a vehicle for reproduction. What’s troubling is that these microbes can mutate
and evolve at fantastic speed – the more so thanks to the burgeoning human population – confronting our bodies
with new dangers every year. HIV, Ebola, bird flu, and antibiotic-resistant “super bugs” are just a few
of the pathogenic threats to humanity that have surfaced over the past few decades. Our soaring numbers,
ubiquitous international travel, and the increasing use of chemicals and biological agents without full knowledge of their
consequences, have increased the risk of unstoppable pandemics arising from mutant viruses and their ilk.
Bubonic plague, the Black Death, and the Spanish Flu are vivid examples from history of how microbial agents can decimate populations. But
the consequences aren’t limited to a high body count. When
the death toll gets high enough, it can disrupt the
very fabric of society. According to U.S. government studies, if a global pandemic affecting at least half the world’s
population were to strike today, health professionals wouldn’t be able to cope with the vast numbers
of sick and succumbing people. The result of so many deaths would have serious implications for
the infrastructure, food supply, and security of 21st century man. While an untreatable pandemic could strike suddenly
and potentially bring civilization to its knees in weeks or months, degenerative diseases might do so over longer periods. The most common
degenerative disease is cancer. Every second men and every third women in the western world will be diagnosed with this disease in their
lifetime. Degeneration of our environment through the release of toxins and wastes, air pollution, and intake of unhealthy foods is making this
problem worse. If cancer, or some other form of degenerative disease, were to become even more commonplace and strike before
reproduction, or become infectious (as seen in the transmitted facial cancer of the Tasmanian Devil, a carnivorous marsupial in Australia) the
very survival of our species could be threatened.
Plan solves 2 internal links-First, It dries up the demand for illegal organs
Upchurch 12 Ryan Upchurch, Seton Hall Law 1-1-12 Seton Hall Law eRepository "The Man who
Removes a Mountain Begins by Carrying Away Small Stones: Flynn v. Holder and a Re-Examination of
The National Organ Transplantation Act of 1984" (2012).
http://erepository.law.shu.edu/student_scholarship/18
By increasing the supply of available organs in the United States through compensation, American
citizens would have less reason to travel elsewhere to pay for an organ. For example, Aadil Hospital in
Lahore, Pakistan advertises two transplant packages catered towards foreign patients: $14,000 for the first transplant and $16,000 for the
second if the first organ fails.118 If
demand dried up from foreign citizens, transplant tourism in these
countries would take a major hit because brokers would fetch lower sums for organs they procure. Statistical information is
difficult to come by for obvious reasons, but presumably American citizens make up a substantial
percentage of the tourist patients seeking a new organ they cannot attain domestically. As
one report about impoverished Bangladeshi villagers taken advantage of for their organs succinctly stated, “Most of those
organs ended up transplanted into American citizens.”119 The black market for organs in other countries is not
fueled by local patients. Rather, it is driven upwards and out of control by those American as well as European citizens who cannot acquire
what they need domestically.120 One estimate is that the black market accounts for as high as twenty percent of all kidney transplants
worldwide.121 Nadley Hakim, transplant surgeon for St. Mary’s Hospital in London, offered an interesting take on this problem of the black
market when he said, “this trade is going on anyway, why not have a controlled trade where if someone wants to donate a kidney for a
particular price, that would be acceptable? If it is done safely, the donor will not suffer.”122 Within the past month, an indigent Chinese
teenager sold his kidney so that he could purchase an iPad and iPhone.123 The unnamed teenager now suffers from renal deficiency.124
Sadly, the boy received roughly ten percent of what the buyer paid, with the rest going to the surgeon and others involved in coordinating
the operation.125 If
those American citizens with the means to purchase were not forced abroad to
find an organ, it is very possible that stories like this would become much less commonplace.
Second, Legalizing organ sales in the US spills over globally
Calandrillo 4 Steve P. Calandrillo, Associate Professor, Univ. of Washington School of Law. J.D.,
Harvard Law School. B.A. in Economics, Univ. of California at Berkeley. George Mason Law Review Fall,
2004 13 Geo. Mason L. Rev. 69 ARTICLE: Cash for Kidneys? Utilizing Incentives to End America's
Organ Shortage lexis
Moreover, if
we cannot prevent the black markets in human organs that continue to thrive
worldwide today, a thoughtful and responsible regulatory solution in America might be the
best response. Many scholars have chronicled the reality that today's black markets lead to a host of abuses, provide for no followup health care, and generally exploit the poor to the wealthy's advantage. n180 Stephen Spurr details the potential for misrepresentation
and fraud against both buyers and sellers today, as prices spiral out of control for organs that are of dubious quality. n181 Gloria Banks
decries the exploitation of society's most vulnerable individuals in the organ sale trade, and urges legal and ethical safeguards for their
protection. n182 Susan Hankin Denise adds that a properly regulated organ market may therefore be a better solution to the problem of
scarcity than the outright ban we witness today. n183 FOOTNOTE ATTACHED n183 See Denise, supra note 72, at 1035-36 (arguing that
regulated markets are superior to the existing ban on organ sales in the U.S.). Of course, even a
well-regulated legalized
market in the U.S. may not completely eliminate black markets worldwide if patients can still find organs
more cheaply abroad. However, it is reasonable to suspect that an American market would
significantly reduce the demand for black market organs, especially given the ability of a
regulated market to better ensure the quality of its product. Furthermore, a legalized market in
the U.S. (with appropriate safeguards to prevent abuse of sellers) may lead to similar structures
abroad. On the other hand, one might argue that competing markets might lead to a "race to the bottom" in terms of regulatory
standards, as each country tries to gain more market share.
Plan
TEXT: The United States federal government should amend the National Organ Transplant Act
to permit regulated sale of human organs. A government agency should be established to
purchase organs, paying cash or credit at an adjusted market-clearing price. Organs should
be placed in the Organ Procurement and Transplantation Network
Contention 3 Solvency
A program with a government intermediary is viable means for "organ sales"
Wilkinson 11 Stephen Wilkinson, Professor of Bioethics, Lancaster University (UK) 10-17-11
Stanford Encyclopedia of Philosophy, "The Sale of Human Organs"
http://plato.stanford.edu/entries/organs-sale/
1.
1. Different Kinds of Organ Sale System The
expression ‘organ sale’ covers a wide range of different
practices. People most readily associate it with the case in which one individual (who needs
or wants money) sells his or her kidney to another (who needs a kidney). But there are other possibilities
too. One (in countries where the prior consent of the deceased is required for cadaveric organ donation) is to pay people living
now for rights over their body after death. Another (in countries where the consent of relatives is required for cadaveric organ
donation) is to pay relatives for transplant rights over their recently deceased loved ones' bodies. Since the kidney is the most
commonly transplanted organ and since the ethics literature on organ sale is mainly about kidney sale from live donors, that is the
practice on which this entry will focus. ‘Organ sale’ as the term is used here does not include the sale of body products (a category
which includes blood, eggs, hair, and sperm) since this is different in some important respects. For example, the risk of permanent
harm is generally much less in the case of blood and hair donation; while, the donation of eggs and sperm raises additional issues
relating to the creation and parenting of additional future people. That said, many of the fundamental issues are similar and the
very same concerns about (for example) exploitation and consent arise in both cases. An important preliminary point is that almost
all serious advocates of allowing payment for human organs argue not for an unfettered ‘free market’ but for a regulated one.
Radcliffe Richards et al. (1998, 1950) for example, in their paper “The Case for Allowing Kidney Sales” say: It must be stressed that
we are not arguing for the positive conclusion that organ sales must always be acceptable, let alone that there should be an
unfettered market. While Wilkinson (2003, 132) is typical of organ sale defenders in wishing to distance himself from today's
(largely ‘underground’) organ trade: … far from being a reason to continue the ban on sale, the dreadfulness of present practice
may be a reason to discontinue prohibition, so that the organ trade can be brought ‘overground’ and properly regulated. Different
scholars have different views about the precise scope and extent of the regulation required, but most support the requirements
that organ sellers give valid consent, are paid a reasonable fee, and are provided with adequate medical care. Taylor (2005, 110)
for example, says that: At minimum … a market should require that vendors give their informed consent to the sale of their
kidneys, that they not be coerced into selling their kidneys by a third party and that they receive adequate post-operative care.
One noteworthy policy proposal comes from Erin and Harris (1994; 2003) who suggest that
a market in human organs should have the following features: It is limited to a particular geopolitical area, such
as a state or the European Union, with only citizens or residents of that area being allowed to sell or to receive organs. There is a
central public body responsible for making (and funding) all purchases and for
allocating organs fairly in accordance with clinical criteria. Direct sales are banned. Prices are
set at a reasonably generous level to attract people voluntarily into the market.
This would maximize organ sales
Erin and Harris 3 Charles A Erin and John Harris, Institute of Medicine, Law and Bioethics, School of
Law, University of Manchester J Med Ethics 2003; 29 :141 Janet Radcliffe Richards on our modest
proposal
http://jme.bmj.com/content/29/3/138.full.pdf+html
Thus when Radcliffe Richards says: “Of course there is something undesirable about a one way international traffic from poor to rich; but
that is not enough to settle the all things considered question of whether it should be allowed” she is again right. It is not enough to settle
that question. Our paper was not trying to settle that question. 2 We
have proposed a scheme that would maximise
organ sales by meeting the most common and persistent objections to commerce in body
parts. In our paper we note that:“In 1994, we made a proposal in which we outlined possibly the only circumstances in which a market
in donor organs could be achieved ethically, and in a way that minimises the dangers normally envisaged for such a scheme” and this is the
proposal that we repeat in abbreviated form. The claim we make, which it seems Radcliffe Richards judges tobe too strong, is that our
proposal outlines “possibly the only circumstances in which a market in donor organs could be achieved ethically”; but note that there is a
qualification to this claim, namely that if the first part of our claim is true it is so because it defends organ sales “in a way that minimises
the dangers normally envisaged for such a scheme”. It may be that organ sales could be defended (possibly by Janet Radcliffe Richards and
for that matter by the present authors) in a way that does not minimise such dangers. But that is not what we were trying to do in our
paper.
government purchaser avoids exploitation
Erin and Harris 3 Charles A Erin and John Harris, Institute of Medicine, Law and Bioethics, School of
Law, University of Manchester,
J Med Ethics 2003;29:137-138 An ethical market in human organs
http://jme.bmj.com/content/29/3/137.full
While people’s lives continue to be put at risk by the dearth of organs available for
transplantation, we must give urgent consideration to any option that may make up the
shortfall. A market in organs from living donors is one such option. The market should be ethically supportable,
and have built into it, for example, safeguards against wrongful exploitation. This can be
accomplished by establishing a single purchaser system within a confined marketplace.
Inequality in ability to purchase is avoided with central purchasing
Radcliffe-Richards et al 98 J. Radcliffe-Richards, Department of Philosophy, the Open University,
Milton Keynes et al J; Daar, A S; Guttmann, R D; Hoffenberg, R; Kennedy, I; Lock, M; Sells, R A;
Tilney, N The Lancet Volume 351(9120) 27 June 1998 pp 1950-1952 The case for allowing kidney
sales
http://elsa.berkeley.edu/pub/users/webfac/held/157_VIII.pdf
Another familiar objection is that it is unfair for the rich to have privileges not available to the
poor. This argument, however, is irrelevant to the issue of organ selling as such. If organ selling is wrong for this reason, so are all
benefits available to the rich, including all private medicine, and, for that matter, all public provision of medicine in rich countries (including
transplantation of donated organs) that is unavailable in poor ones. Furthermore, all
purchasing could be done by a
central organization responsible for fair distribution. [12]
Iran Proves success; recent problems have been because of budget cuts
Beard et al 13 T. Randolph "Randy" Beard, Professor of Economics at Auburn University.; Rigmar
Osterkamp, Fellow at the School for Political Studies at University of Munich.; And David L. Kaserman,
Torchmark Professor of Economics at Auburn University.2013 The Global Organ Shortage: Economic
Causes, Human Consequences, Policy Responses
The Iranian system has, by most accounts, been successful historically, increasing the numbers
of transplants performed by 577 percent between 1988 and 2003. This result has been obtained
within a bureaucratized framework in which religious judges examine potential living donors, looking
for signs of coercion or mixed motivations. Great emphasis has been placed on continuing care for
donors, with medical follow-up, insurance benefits, and so on made widely available, at least in
principle. Foreigners may not donate or receive a transplant in Iran, except under special, rare
circumstances. This latter practice has apparently gone some distance in allowing Iran to avoid the
sorts of com¬mercialization that would offend ethical sensibilities.
However, a recent lack of public funding seems to have undermined the past successes.
Zargooshi (2008a, b) reports that the recent annual kidney transplant figure has decreased and now
amounts to about one-tenth of the annual number of new ESRD patients. Obviously, the official
public payment to donors of Tolman Imio (around U.S.$1,000) has been eroded by inflation. Kidney
vendors seem to ask for increasing private copayments from the re¬cipients. The "market price" for a
donation is now likely to be around three times the official public payment. During certain periods, it
is reported that the public system was unable to pay any compensation to donors. Lack of public
funds seems to have also eroded the formerly strictly regulated donor system, and today there is a
tolerated "free market" in which recipient income status has become a major determinant in the
acquisition of a kidney. Thus, although the Iranian experience strongly suggested the viability of
compensated living-donor kidney supply in some settings, it also provides a cautionary tale regarding
the consequences of underfunding for such systems.
Organ sales are key—artificial organs can’t solve
O'Sullivan 11 Sophia O'Sullivan, historical contributor 9 August 2011 Heart to Heart- An
Investigation of Globalisation and the Illegal Organ Trade
http://smartsgroupd.blogspot.com/p/sophia.html
As the demand for organs rises, and waiting list times stretch out by years, it seems logical that the illegal organ trade will grow. A
significant improvement in the lifestyles of first world countries and new cures for organ-destroying disease may reduce the demand for
organs. However, the
best alternative to organ transplantation appears to be the artificial growth of
organs in a laboratory. The Human Genome Project reports that while this is still a science in
its early stages, these organs would be a healthy clone of the organ in need of replacing and would contain the patient’s DNA, thus
reducing the risk of rejection. It is likely that this will not become as widespread as transplantation for
at least a decade; ethical, legal and clinical concerns must be addressed before such a
treatment is perfected and offered to the public. It is interesting to note that, at present, these
organs are grown from embryonic stem cells, a process which many consider unethical. It is
for this reason that this science has stalled; conservative legislators refuse to allocate
government funding to the development of embryonic technology. In the face of a possible solution to the
exploitative organ trade, is it morally better to allow the destruction of embryos or to allow the organ trade, which harms donors and
The impact
that this “organ growing” has on the illegal organ trade will undoubtedly be determined by
the cost to the party in need of an organ; it is safer and preferable than travelling overseas for a transplant but if it is
recipients, to continue? These are questions which those in government and medical technology sectors must address.
significantly more expensive the organ trade may still thrive. Another possibility is that the organ trade will be opened to classes in the
donor country; relatively wealthy residents in a poor country may be able to buy organs from those who would have previously sold organs
to foreigners. There is an increased international awareness of the epidemic of the organ trade, and legislation of both vendors and
recipients is becoming tougher. However, if
the international response is to be truly successful in ceasing
the exploitation of such desperate people, all nations must look inwards to solve the problems of
inescapable poverty and inadequate healthcare systems.
Crowd out would not be a net reduction
Erin and Harris 94 Charles A Erin and John Harris, Institute of Medicine, Law and Bioethics, School of
Law, University of Manchester 1994 A monopsonistic market: or how to buy and sell human organs,
tissues and cells ethically in Life and Death Under High Technology Medicin, edited by Ian Robinson
Arguing for commerce in the context of organs obtained from cadavers is less morally problematic
than in the case of the living. For a start, a cadaver cannot be argued, reasonably, to be a person and
thus considerations of personal autonomy do not enter the picture: to talk of the autonomy of the
dead is absurd. Each year several thousands of persons die prematurely from the lack of donated
organs. Certain organs, hearts for example, can only be obtained from cadavers? Whilst this shortfall
of cadaver organs for transplantation persists it seems morally insupportable to ignore policies which
would likely save lives unless they are counterbalanced by arguments of comparable moral force.
Such policies could include offering prospective payments for organs retrieved post mortem,
Such prospective payments, whether in money or present medical care, are currently offered in
some American states in return for the delivery of one’s body at death (Munzer 1990 p. 52). It has
been argued that this would lead to a fall in the numbers of organs donated on purely
humanitarian or altruistic groundsf but nevertheless it seems probable that the introduction
of such a commercial interest would lead to an overall increase in organ yield (Brams 1977; Buc
and Bernstein 1984).
Contention 4: no war
Great power war is obsolete – globalization, nuclear deterrence, and the cooperative
liberal order ensure no conflict
Ikenberry and Deudney 9 (Daniel – Professor of Politics and International Affairs at Princeton
University, and G. John – professor of political science at Johns Hopkins University, Jan/Feb, “The Myth
of the Autocratic Revival,” Foreign Affairs, Vol. 88, Issue 1, p. 8)
It is in combination with these factors that the regime divergence between autocracies and democracies will become increasingly dangerous. If all the states in the
world were democracies, there would still be competition, but a world riven by a democratic-autocratic divergence promises to be even more conflictual. There are
even signs of the emergence of an "autocrats international" in the Shanghai Cooperation Organization, made up of China, Russia, and the poorer and weaker
Central Asian dictatorships. Overall, the autocratic revivalists paint the
picture of an international system marked by rising levels
of conflict and competition, a picture quite unlike the "end of history" vision of growing convergence and cooperation. This bleak outlook is based
on an exaggeration of recent developments and ignores powerful countervailing factors and forces. Indeed, contrary to
what trhe revivalists describe, the most striking features of the contemporary international landscape are the
intensification of economic globalization, thickening institutions, and shared problems of interdependence. The
overall structure of the international system today is quite unlike that of the nineteenth century. Compared to older
orders, the contemporary liberal-centered international order provides a set of constraints and
opportunities — of pushes and pulls — that reduce the likelihood of severe conflict while creating strong
imperatives for cooperative problem solving. Those invoking the nineteenth century as a model for the twenty-first also fail to
acknowledge the extent to which war as a path to conflict resolution and great-power expansion has become largely obsolete. Most
important, nuclear weapons have transformed great-power war from a routine feature of international politics into an
exercise in national suicide. With all of the great powers possessing nuclear weapons and ample
means to rapidly expand their deterrent forces, warfare among these states has truly become an option of last resort. The
prospect of such great losses has instilled in the great powers a level of caution and restraint that
effectively precludes major revisionist efforts. Furthermore, the diffusion of small arms and the near
universality of nationalism have severely limited the ability of great powers to conquer and
occupy territory inhabited by resisting populations (as Algeria, Vietnam, Afghanistan, and now Iraq have demonstrated). Unlike during the days of empire
building in the nineteenth century, states today cannot translate great asymmetries of power into effective territorial control; at most, they can hope for loose
density of trade,
investment, and production networks across international borders raises even more the costs of
war. A Chinese invasion of Taiwan, to take one of the most plausible cases of a future interstate war, would pose for the Chinese communist regime daunting
hegemonic relationships that require them to give something in return. Also unlike in the nineteenth century, today the
economic costs, both domestic and international. Taken together, these changes in the economy of violence mean that the international system is far more primed
for peace than the autocratic revivalists acknowledge. The autocratic revival thesis neglects other key features of the international system as well. In the nineteenth
century, rising states faced an international environment in which they could reasonably expect to translate their growing clout into geopolitical changes that would
benefit themselves. But in
the twenty-first century, the status quo is much more difficult to overturn.
Simple comparisons between China and the United States with regard to aggregate economic size and
capability do not reflect the fact that the United States does not stand alone but rather is the
head of a coalition of liberal capitalist states in Europe and East Asia whose aggregate assets far exceed
those of China or even of a coalition of autocratic states. Moreover, potentially revisionist autocratic states, most notably China
and Russia, are already substantial players and stakeholders in an ensemble of global institutions that make up
the status quo, not least the UN Security Council (in which they have permanent seats and veto
power). Many other global institutions, such as the International Monetary Fund and the World Bank, are configured in
such a way that rising states can increase their voice only by buying into the institutions. The
pathway to modernity for rising states is not outside and against the status quo but rather inside and
through the flexible and accommodating institutions of the liberal international order. The fact that these autocracies are capitalist has
profound implications for the nature of their international interests that point toward integration and accommodation in the future. The domestic viability
of these regimes hinges on their ability to sustain high economic growth rates, which in turn is crucially
dependent on international trade and investment; today's autocracies may be illiberal, but they remain fundamentally dependent on a
liberal international capitalist system. It is not surprising that China made major domestic changes in order to join the WTO or that Russia is seeking to do so now.
The dependence of autocratic capitalist states on foreign trade and investment means that they have a fundamental interest in maintaining an open, rulebased
economic system. (Although these autocratic states do pursue bilateral trade and investment deals, particularly in energy and raw materials, this does not obviate
their more basic dependence on and commitment to the WTO order.) In the case of China, because of its extensive dependence on industrial exports, the WTO may
act as a vital bulwark against protectionist tendencies in importing states. Given their position in this system, which so serves their interests, the autocratic states
are unlikely to become champions of an alternative global or regional economic order, let alone spoilers intent on seriously damaging the existing one. The
prospects for revisionist behavior on the part of the capitalist autocracies are further reduced by the large and growing social networks across international borders.
Not only have these states joined the world economy, but their people — particularly upwardly mobile and
educated elites — have increasingly joined the world community. In large and growing numbers, citizens of
autocratic capitalist states are participating in a sprawling array of transnational educational, business, and avocational
networks. As individuals are socialized into the values and orientations of these networks, stark: "us versus them" cleavages become
more difficult to generate and sustain. As the Harvard political scientist Alastair Iain Johnston has argued, China's ruling elite has also been
socialized, as its foreign policy establishment has internalized the norms and practices of the international diplomatic community. China, far from cultivating causes
for territorial dispute with its neighbors, has instead sought to resolve numerous historically inherited border conflicts, acting like a satisfied status quo state.
These social and diplomatic processes and developments suggest that there are strong
tendencies toward normalization operating here. Finally, there is an emerging set of global problems stemming from industrialism
and economic globalization that will create common interests across states regardless of regime type. Autocratic China is as dependent on imported oil as are
democratic Europe, India, Japan, and the United States, suggesting an alignment of interests against petroleum-exporting autocracies, such
as Iran and Russia. These states share a common interest in price stability and supply security that could form the basis for a
revitalization of the International Energy Agency, the consumer association created during the oil turmoil of the 1970s. The emergence of global warming and
climate change as significant problems also suggests possibilities for alignments and cooperative ventures cutting across the autocratic-democratic divide. Like the
United States, China is not only a major contributor to greenhouse gas accumulation but also likely to be a major victim of climate-induced desertification and
coastal flooding. Its rapid industrialization and consequent pollution means that China, like other developed countries, will increasingly need to import technologies
and innovative solutions for environmental management. Resource scarcity and environmental deterioration pose global threats that no state will be able to solve
alone, thus placing a further premium on political integration and cooperative institution building . Analogies between the nineteenth century and the twenty-first
are based on a severe mischaracterization of the actual conditions of the new era. The
declining utility of war, the thickening of international
emerging resource and environmental interdependencies together undercut
scenarios of international conflict and instability based on autocratic-democratic rivalry and autocratic revisionism. In fact, the
conditions of the twenty-first century point to the renewed value of international integration and
cooperation.
transactions and institutions, and
Nuclear deterrence checks – all states are rational
Tepperman 9 (John - journalist based in New York Cuty, Why obama should learn to love the bomb,
Newsweek, 9/7, p.lexis)
A growing and compelling body of research suggests that nuclear weapons may not, in fact, make the
world more dangerous, as Obama and most people assume. The bomb may actually make us safer. In this era of rogue states and
transnational terrorists, that idea sounds so obviously wrongheaded that few politicians or policymakers are willing to entertain it. But that's a
mistake. Knowing the truth about nukes would have a profound impact on government policy. Obama's idealistic campaign, so out of character
for a pragmatic administration, may be unlikely to get far (past presidents have tried and failed). But it's not even clear he should make the
effort. There are more important measures the U.S. government can and should take to make the real world safer, and these mustn't be
ignored in the name of a dreamy ideal (a nuke-free planet) that's both unrealistic and possibly undesirable. The argument that nuclear
weapons can be agents of peace as well as destruction rests on two deceptively simple observations. First,
nuclear weapons have not
been used since 1945. Second, there's never been a nuclear, or even a nonnuclear, war between two
states that possess them. Just stop for a second and think about that: it's hard to overstate how remarkable it is, especially given the
singular viciousness of the 20th century. As Kenneth Waltz, the leading "nuclear optimist" and a professor emeritus of political science at UC
Berkeley puts it, "We now have 64 years of experience since Hiroshima. It's striking and against all historical precedent that for that substantial
period, there has not been any war among nuclear states." To understand why--and why the next 64 years are likely to play out the same way-you need to start by recognizing that all
states are rational on some basic level. Their leaders may be stupid,
petty, venal, even evil, but they tend to do things only when they're pretty sure they can get away with
them. Take war: a country will start a fight only when it's almost certain it can get what it wants at an
acceptable price. Not even Hitler or Saddam waged wars they didn't think they could win. The problem
historically has been that leaders often make the wrong gamble and underestimate the other side--and
millions of innocents pay the price. Nuclear weapons change all that by making the costs of war
obvious, inevitable, and unacceptable. Suddenly, when both sides have the ability to turn the other to ashes with the push of a
button--and everybody knows it--the basic math shifts. Even the craziest tin-pot dictator is forced to accept that war
with a nuclear state is unwinnable and thus not worth the effort. As Waltz puts it, "Why fight if you
can't win and might lose everything?" Why indeed? The iron logic of deterrence and mutually assured
destruction is so compelling, it's led to what's known as the nuclear peace: the virtually unprecedented stretch since
the end of World War II in which all the world's major powers have avoided coming to blows. They did fight proxy wars, ranging from Korea to
Vietnam to Angola to Latin America. But these never matched the furious destruction of full-on, great-power war (World War II alone was
responsible for some 50 million to 70 million deaths). And since the end of the Cold War, such bloodshed has declined precipitously.
Meanwhile, the
nuclear powers have scrupulously avoided direct combat, and there's very good reason to
think they always will. There have been some near misses, but a close look at these cases is
fundamentally reassuring--because in each instance, very different leaders all came to the same safe conclusion.
Take the mother of all nuclear standoffs: the Cuban missile crisis. For 13 days in October 1962, the United States and the Soviet Union
each threatened the other with destruction. But both countries soon stepped back from the brink when they
recognized that a war would have meant curtains for everyone. As important as the fact that they did is the reason why:
Soviet leader Nikita Khrushchev's aide Fyodor Burlatsky said later on, "It is impossible to win a nuclear war, and both sides realized that, maybe
The record since then shows the same pattern repeating: nuclear-armed enemies slide
toward war, then pull back, always for the same reasons. The best recent example is India and Pakistan,
which fought three bloody wars after independence before acquiring their own nukes in 1998. Getting their hands on weapons of
mass destruction didn't do anything to lessen their animosity. But it did dramatically mellow their
behavior. Since acquiring atomic weapons, the two sides have never fought another war, despite
severe provocations (like Pakistani-based terrorist attacks on India in 2001 and 2008). They have skirmished once. But during that
for the first time."
flare-up, in Kashmir in 1999, both countries were careful to keep the fighting limited and to avoid threatening the other's vital interests. Sumit
Ganguly, an Indiana University professor and coauthor of the forthcoming India, Pakistan, and the Bomb, has found that on both
sides, officials' thinking was strikingly similar to that of the Russians and Americans in 1962. The prospect of
war brought Delhi and Islamabad face to face with a nuclear holocaust, and leaders in each country did what they had to do to avoid it.
Great power war is obsolete and small conflicts will not escalate
Mandelbaum 99 (Michael, Professor of American Foreign Policy, Johns Hopkins University; Director,
Project on East-West Relations, Council on Foreign Relations, “Transcript: is Major War Obsolete?”
Transcript of debate with John Mearsheimer, CFR, Feb 25, http://www.ciaonet.org/conf/cfr10/)
My argument says, tacitly, that while this point of view, which was widely believed 100 years ago, was not true then, there are reasons to think that it is true now.
What is that argument? It is that major
war is obsolete. By major war, I mean war waged by the most powerful members of the international system,
using all of their resources over a protracted period of time with revolutionary geopolitical consequences. There have been four such wars in the modern period:
the wars of the French Revolution, World War I, World War II, and the Cold War. Few though they have been, their consequences have been monumental. They are,
by far, the most influential events in modern history. Modern history which can, in fact, be seen as a series of aftershocks to these four earthquakes. So if I am right,
then what has been the motor of political history for the last two centuries that has been turned off? This war, I argue, this
than impossible, but more
kind of war, is obsolete; less
than unlikely. What do I mean by obsolete? If I may quote from the article on which this presentation is based, a copy of
which you received when coming in, “ Major war is obsolete in a way that styles of dress are obsolete. It is something that is out of fashion and, while it could be
revived, there is no present demand for it. Major
war is obsolete in the way that slavery, dueling, or foot-binding are
obsolete. It is a social practice that was once considered normal, useful, even desirable, but that now seems odious. It is obsolete in the way that the central
planning of economic activity is obsolete. It is a practice once regarded as a plausible, indeed a superior, way of achieving a socially desirable goal, but that changing
conditions have made ineffective at best, counterproductive at worst.” Why is this so? Most simply, the costs
have risen and the benefits of
major war have
shriveled. The costs of fighting such a war are extremely high because of the advent in the middle of this century of nuclear
weapons, but they would have been high even had mankind never split the atom. As for the benefits, these now seem, at least from the point of
view of the major powers, modest to non-existent. The traditional motives for warfare are in retreat, if not extinct. War is
no longer regarded by anyone, probably not even Saddam Hussein after his unhappy experience, as a paying proposition. And as for
the ideas on behalf of which major wars have been waged in the past, these are in steep decline. Here the collapse of
communism was an important milestone, for that ideology was inherently bellicose. This is not to say that the world has reached the end of ideology; quite the
contrary. But the
ideology that is now in the ascendant, our own, liberalism, tends to be pacific. Moreover, I would argue
post-Cold War developments have made major war even less likely than it was after 1945. One of these
is the rise of democracy, for democracies, I believe, tend to be peaceful. Now carried to its most extreme conclusion, this
that three
eventuates in an argument made by some prominent political scientists that democracies never go to war with one another. I wouldn’t go that far. I don’t believe
that this is a law of history, like a law of nature, because I believe there are no such laws of history. But I do believe there is something in it. I believe there is a
peaceful tendency inherent in democracy. Now it’s true that one important cause of war has not changed with the end of the Cold War. That is the structure of the
international system, which is anarchic. And realists, to whom Fareed has referred and of whom John Mearsheimer and our guest Ken Waltz are perhaps the two
most leading exponents in this country and the world at the moment, argue that that structure determines international activity, for it leads sovereign states to
have to prepare to defend themselves, and those preparations sooner or later issue in war. I argue, however, that a
post-Cold War innovation
counteracts the effects of anarchy. This is what I have called in my 1996 book, The Dawn of Peace in Europe, common security. By
common security I mean a regime of negotiated arms limits that reduce the insecurity that anarchy inevitably produces by transparencyevery state can know what weapons every other state has and what it is doing with them-and through the principle of defense dominance,
the reconfiguration through negotiations of military forces to make them more suitable for defense and
less for attack. Some caveats are, indeed, in order where common security is concerned. It’s not universal. It exists only in Europe. And there it is certainly
not irreversible. And I should add that what I have called common security is not a cause, but a consequence, of the major forces that have made war less likely.
States enter into common security arrangements when they have already, for other reasons, decided that they do not wish to go to war. Well, the third feature of
the post-Cold War international system that seems to me to lend itself to warlessness is the novel distinction
between the periphery and the core,
between the powerful states and the less powerful ones. This was previously a cause of conflict and now is far less
important. To quote from the article again, “ While for much of recorded history local conflicts were absorbed into great-power conflicts, in the wake
of the Cold War, with the industrial democracies debellicised and Russia and China preoccupied with
internal affairs, there is no great-power conflict into which the many local conflicts that have erupted
can be absorbed. The great chess game of international politics is finished, or at least suspended. A pawn is now
just a pawn, not a sentry standing guard against an attack on a king.”
Nuclear war doesn’t cause extinction
Socol 11 (Yehoshua (Ph.D.), an inter-disciplinary physicist, is an expert in electro-optics, high-energy
physics and applications, and material science and Moshe Yanovskiy, Jan 2, “Nuclear Proliferation and
Democracy”, http://www.americanthinker.com/2011/01/nuclear_proliferation_and_demo.html)
Nuclear proliferation should no longer be treated as an unthinkable nightmare; it is likely to be the future reality. Nuclear weapons have been
acquired not only by an extremely poor per capita but large country such as India, but also by even poorer and medium-sized nations such as
Pakistan and North Korea. One could also mention South Africa, which successfully acquired a nuclear arsenal despite economic sanctions (the
likes of which have not yet been imposed on Iran). It is widely believed that sanctions and rhetoric will not prevent Iran from acquiring nuclear
weapons and that many countries, in the Middle East and beyond, will act accordingly (see, e.g., recent Heritage report). Nuclear Warfare --
consequences of the limited use of nuclear weapons -- especially low-yield devices most likely to be
in the hands of non-state actors or irresponsible governments -- would probably not be great enough to bring about significant
geopolitical upheavals. Casualties from a single 20-KT nuclear device are estimated [1] at about 25,000 fatalities with a similar
Myths And Facts The direct
number of injured, assuming a rather unfortunate scenario (the center of a large city, with minimal warning). Scaling the above toll to larger
devices or to a larger number of devices is less than linear. For example, it has been estimated that it would take as many as eighty devices of
20-KT yield each to cause 300,000 civilian fatalities in German cities (a result actually achieved by Allied area attacks, or carpet-bombings,
during the Second World War). A single 1-MT device used against Detroit has been estimated by U.S. Congress OTA to result in about 220,000
civil defense measures, based on rather simple presently known techniques, would
decrease these numbers by maybe an order of magnitude (as will be discussed later). There is little doubt that a
nation determined to survive and with a strong sense of its own destiny would not succumb to such losses. It is often
fatalities. It is anticipated that well-prepared
fallout effects of even the limited use of nuclear weapons would be worldwide and would last for generations. This is
an exaggeration. The following facts speak for themselves. -- In Japan, as assessed by REFR, less than 1,000 excess cancer
cases (i.e., above the natural occurrence) were recorded in over 100,000 survivors over the past sixty years -- compared with
argued that the
about 110,000 immediate fatalities in the two atomic bombings. No clinical or even sub-clinical effects were discovered in the survivors'
offspring. -- In the Chernobyl area, as assessed by IAEA, only fifteen cancer deaths can be directly attributed to fallout radiation. No radiationrelated increase in congenital formations was recorded. Nuclear Conflict -- Possible Scenarios With reference to a possible regional nuclear
conflict between a rogue state and a democratic one, the no-winner (mutual assured destruction) scenario is probably false. An analysis by
Anthony Cordesman, et al. regarding a possible Israel-Iran nuclear conflict estimated that while Israel might survive an Iranian nuclear blow,
Iran would certainly not survive as an organized society. Even though the projected casualties cited in that study seem to us overstated,
especially as regards Israel, the conclusion rings true. Due
to the extreme high intensity ("above-conventional") of nuclear
conflict, it is nearly certain that such a war, no matter its outcome, would not last for years, as we have become accustomed to in
current low-intensity conflicts. Rather, we should anticipate a new geo-political reality: the emergence of clear winners and losers
within several days, or at most weeks after the initial outbreak of hostilities. This latter reality will most probably contain fewer nuclearpossessing states than the former.
No nuke winter – studies
Seitz 11 (Russell, Harvard University Center for International Affairs visiting scholar, “Nuclear winter
was and is debatable,” Nature, 7-7-11, Vol 475, pg37)
Alan Robock's contention that there has been no real scientific debate about the 'nuclear winter' concept is itself debatable (Nature 473,
potential climate disaster, popularized in Science in 1983, rested on the output of a one-dimensional
model that was later shown to overestimate the smoke a nuclear holocaust might engender. More refined estimates, combined
275–276; 2011). This
with advanced three-dimensional models (see http://go.nature.com.libproxy.utdallas.edu/kss8te), have dramatically reduced the extent and
severity of the projected cooling. Despite this, Carl Sagan, who co-authored the 1983 Science paper, went so far as to posit “the extinction of
Homo sapiens” (C. Sagan Foreign Affairs 63, 75–77; 1984). Some
regarded this apocalyptic prediction as an exercise in
mythology. George Rathjens of the Massachusetts Institute of Technology protested: “Nuclear winter is the worst
example of the misrepresentation of science to the public in my memory,” (see
http://go.nature.com.libproxy.utdallas.edu/yujz84) and climatologist Kerry Emanuel observed that the subject had “become
notorious for its lack of scientific integrity” (Nature 319, 259; 1986). Robock's single-digit fall in temperature is at odds with the
subzero (about −25 °C) continental cooling originally projected for a wide spectrum of nuclear wars. Whereas Sagan predicted darkness at noon
from a US–Soviet nuclear conflict, Robock projects global sunlight that is several orders of magnitude brighter for a Pakistan–India conflict —
literally the difference between night and day. Since 1983,
the projected worst-case cooling has fallen from a Siberian deep freeze
numbers so unseasonably small as to call the very term
spanning 11,000 degree-days Celsius (a measure of the severity of winters) to
'nuclear winter' into question.