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Prohibition of Compensation for Human Transplant Organs in NOTA Should Be Repealed and a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
Policy
Winter 2008 Regulation
The Failure of US 'Organ Procurement
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 currency-based 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 barterbased 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
Policy
Winter 2008 Regulation
The Failure of US 'Organ Procurement
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 the changed
technological realities of the transplant industry have been unconscionable. Figure 2, above, suggests
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
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.
Waitlist underestimates the need for kidney transplants
Goodwin 9 MICHELE GOODWIN Everett Fraser Professor of Law and Professor of Medicine and
Public Health, University of Minnesota Law School. SAINT LOUIS UNIVERSITY JOURNAL OF
HEALTH LAW & POLICY [Vol. 2:327 2009] CONFRONTING THE LIMITS OF ALTRUISM: A
RESPONSE TO JAKE LINFORD
Of the patients in line for organs, most need kidneys.29 In fact, three quarters of the transplant waitlist
consists of patients needing kidneys. At the end of February 2009, there were 83,447 registrants
waiting for kidneys.30 But that number tells us less than what we really need to know. For example,
that figure undercounts the actual number of patients that would benefit from a kidney transplant,
because it does not account for the 485,000 Americans with end-stage renal disease, or the more than
341,000 who are on dialysis, those who are registered on Internet websites, like matchingdonor.com,
or those who decided that the black market might be far more expedient than waiting in the U.S. To
be sure, the gains in organ donation pale in comparison with the number of registered patients who can
expect to die before ever receiving a transplant.
Organs from cadavers don’t solve
Fry-Revere 14 Sigrid Fry-Revere. Director of bioethics studies, CATO Institute 2014
The Kidney Sellers: A Journey of Discovery in Iran p 6
At the time, what Congress did seemed reasonable, but over the following three decades, no matter
how efficient the U.S. cadaver organ procurement sys- tem became, it could not satisfy the demand.
Medical innovations keep people alive longer, and the ever-growing diabetes and hypertension
epidemics contin- ually increased the number of people who could benefit from a kidney transplant.
Today the number of kidneys provided from cadavers could never be enough, even if every organ
from every potential qualified donor could be harvested. This is true because not every death results
in useable organs. Organs can be diseased or injured, or the body can be dead too long before it
reaches the hospital. Patients who die in the hospital after a car accident or similar trauma are the
best potential organ donors because the appropriate medical equip- ment is at hand to switch gears
from saving the patient to preserving organs for transplantation. Nevertheless, given what we know
now, no matter how the process for retrieving organs from the dead improves, there will never be
enough kidneys to meet the ever-growing demand.
Artificial organs don’t work
Adhikari 14 Richard Adhikari has written about high-tech for leading industry publications since the 1990s
03/26/14 Bioprinting, Part 1: The Promise and the Pitfalls http://www.technewsworld.com/story/80198.html
[According to Jordan Miller, assistant professor of bioengineering at Rice University]. "Parts of the
body which require human cells to perform biomechanical functions, such as the liver or kidney, are
still several decades away from reaching human patients," Miller said. "We are still in the feasibility
stage -- not sure how to keep cells alive at high cell density and adequate size needed to match
human organs." A 3D structure will require nearly 1 billion functioning cells to approximate the
function of a liver or kidney, and "there are dozens of cell types in these organs," Miller pointed out.
"We are typically only looking at one or two cell types being put into a 3D printed structure."
NOTE SOURCE WITH QUALS EDITED INTO BEGINNING OF CARD
And they’re too expensive
Gopar 14 Jennifer Julisa Gopar ans Dr. Rance LeFebvre 28 July 2014 COSMOS Cluster 7:
Biomedical Sciences The Moral and Ethical Debate Regarding Artificial Organ Growth
http://cosmos.ucdavis.edu/archives/2014/Cluster7/Gopar_Jennifer_EthicsofGrowingOrgans.pdf
With these possible outcomes taken consideration, it is now becoming clear that money will play an
important role in artificial organ growth. If we begin producing artificial organs, will these be
available to everyone? Or will these be only available to the wealthy? The whole purpose of artificial
organ growth is to give hope to those waiting for an organ transplant. How would this fulfill that
purpose if only the wealthy will be able to afford it? The Scientist elaborated on this possible
problem, stating, “[Jeffrey] Platt thinks that organ engineering is too costly to meet the needs of
everyone waiting for a transplant. ‘You’d have to turn over the entire GDP of a country to
accomplish that,’ he says. On the other hand, ‘I could get a pig for a couple of hundred dollars.’ But
[Paolo] Macchiarini argues that organ engineering is in its infancy, and every advance improves
efficiency and lowers cost. ‘What we did in 2008 in 6 months, we can now do in a few weeks,’ he
says. ‘We do care about getting this to every patient.’ [Joseph] Vacanti adds that mass-producing
artificial scaffolds will make organ engineering even more cost-effective. ‘When you scale them up,
the bulk materials and manufacturing tech are extremely cheap,’ he says. ‘I think it’s going to be
cheaper than growing lots of pigs.’” So it is still unclear whether the cost of these artificial organs will
allow them to be within the reach of patients in need of an organ transplant.
Crowd-out studies are based on Titmuss, who’s wrong
Economist 11
The Economist Feb 16th 2011 Blood, not money
http://www.economist.com/blogs/blighty/2011/02/volunteering_and_profiteering
Blood donors are also unpaid, in Britain and elsewhere. A debate over whether or not they should be
compensated for their efforts has raged for at least four decades. In a classic 1970 study called "The
Gift Relationship: From Human Blood to Social Policy" Richard Titmuss compared the voluntary
British system favourably with the American one in which payments were then widely made. Titmuss
reckoned such a market was inefficient and wasteful, that it created shortages and surpluses, and led
eventually to a contaminated product. Although he was wrong, and such arguments have since been
widely discredited, Americans mostly no longer receive payment for giving blood. Too many people
in poor health lied about their medical histories in order to make a few bucks, endangering those
who were to receive the blood. As the World Health Organisation notes, people who give blood
voluntarily and for altruistic reasons have a lower prevalence of HIV, hepatitis viruses and other
blood-borne infections than do those who seek monetary reward. Presumably that is because being
rich is a great protection against disease.
New empirical data proves no altruism crowd out
Elisa J Gordon 15, PhD/MPH-Research Associate Professor in Center for Healthcare Studies - Institute
for Public Health and Medicine, Medical Education-Medical Humanities and Bioethics and Surgery-
Organ Transplantation at Northwestern University, “Does Financial Compensation for Living Kidney
Donation Change Willingness to Donate?,” American Journal of Transplantation, Volume 15, Issue 1,
pages 265–273, January 2015
This study assessed public perceptions about the impact of compensation on willingness to donate, the
amount of compensation that would begin motivating individuals to donate, and the amount that starts to be perceived as undue inducement.¶
The majority of the public surveyed perceived financial compensation for living donors acceptable in
general. However, fewer respondents considered financial compensation to themselves to donate acceptable. Moreover, the majority
(70%) would not change their willingness to donate if offered financial compensation, and 74%
found an offer of compensation to others acceptable, which, together, undermines the positive crowding
out hypothesis that the offer of compensation reduces a desired behavior in those already disposed to
pursuing the desired behavior. Bryce et al similarly found 71–76% maintaining the same willingness to be
a deceased donor, depending on the type of compensation [28]. Our finding suggests that respondents were against
personally receiving financial compensation. In other words, this disconnection between tolerance for compensating others and less support for
personal compensation suggests that financial compensation would make little difference in individuals' decisions to donate, and that in practice,
policies in support of financial compensation would have relatively little traction in increasing living donation rates.
No crowd out – donations are primarily for friends and relatives
Gill 2 Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert
Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care,
Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45
Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_
of_ethics_journal/v012/12.1gill.html
3. In the early 1970s, Titmuss (1971) and Singer (1973) argued that the existence of financial incentives
for blood products would decrease the amount of blood products overall, and some people might
believe that the same argument can be extended to financial incentives for kidneys, leading to the
conclusion that payment for kidneys will decrease the overall number of kidneys available for
transplant. Singer and Titmuss's criticisms of payment for blood products are consequentialist—they
argue that such payment is wrong because it would reduce the amount of blood for people who needed
it. We believe, first of all, that their consequentialist arguments against payment for blood products
have turned out to be inconclusive at best—that the available evidence does not support the conclusion
that payment for blood products has reduced blood supply in the United States. And we believe,
secondly, that because live kidney donations are usually between family members, there is a significant
difference between blood and kidneys that makes it illegitimate to transfer Titmuss and Singer's
conclusions to the kidney debate. We do, however, remain open to the possibility that future evidence
may vitiate our belief that payment for kidneys will increase supplies. For discussion of Titmuss and
Singer in relation to kidney sales, see Campbell (1992, pp. 41-42); Cherry (2000, pp. 340-41); and Harvey
(1999, p. 119).
Even if some crowd out occurred, sales would still provide an adequate supply of
organs
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_hp
p_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 4.5year 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 the Illegal market
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
Trafficking is increasing now—global legislation is ineffective—most recent trends
prove
Da Silva and Frontera 15 (Ivan Rocha Ferreira Da Silva, MD1; Jennifer A. Frontera, MD2 Neurocritical
Care Unit and Stroke Department, Hospital Copa D’Or, Rio de Janeiro, Brazil 2Cerebrovascular Center
of the Neurological Institute, Cleveland Clinic, Cleveland, Ohio “Worldwide Barriers to Organ Donation”
JAMA Neurol. 2015;72(1):112-118. doi:10.1001/jamaneurol.2014.3083.
http://archneur.jamanetwork.com/article.aspx?articleid=1934718)
Globally, legislation guiding organ donation and transplant varies widely.1 Only 20% of African nations
report having a transplant and organ donation coordinating structure, while 95% of countries in the Americas have such a
system in place. Even fewer countries have a mechanism for collection and analysis of data related to
donation, donor safety, and transplantation activities. Some countries report that liver and/or kidney transplants are
performed despite a lack of legislation. Such lack of oversight may promulgate illegal transplantation and
organ trafficking. Even in countries that have legislation regulating organ trafficking, there is weak
enforcement and few international regulations that can effectively police the problem.43 A recent report by
Global Financial Integrity estimates that the illicit organ trade generates illegal profits between $600 million and $1.2 billion per
year.44 It is hypothesized that this market is fueled not only by profit but also by cultural and religious barriers to organ
donation and transplantation in some countries, long waiting lists for organs, precarious infrastructure for transplants in the country of
origin, and difficult access to chronic life support (in the case of renal replacement therapy).45 A growing number of countries
report that patients have allegedly traveled to countries to buy organs on the black (illicit) market, a practice
known as transplant tourism. The World Health Organization estimates that 5% to 10% of kidney transplants worldwide occur as a
result of commercial transactions.46,47 A study of American citizens who received organ transplants abroad showed that roughly 90%
were kidney transplants and that male sex, Asian race, resident and nonresident alien status, and college education were significantly and
independently associated with foreign transplant.48 In 2006, patients from 34 states, plus the District of Columbia, received
foreign
transplants in 35 countries, led by China, the Philippines, and India.48
People sell organs out of economic desperation, but the illicit market leaves them
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 long-term 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
The illegal market is also a threat to public health – spreads antibiotic-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
The availability of organs in the US would dry up demand in the illegal market
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 ReExamination 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.
Legalizing sales in the US would take down the illegal market
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 follow-up
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
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 from those living in the United States, with
payment in vouchers with a cash value set at an adjusted market-clearing price.
Organs should be placed in the Organ Procurement and Transplantation Network.
Contention 3 The Plan solves
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,
organs
J Med Ethics 2003;29:137-138 An ethical market in human
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.
We legalize sales, not purchases – their turns don’t apply
Gill 2 Michael Gill, Ph.D., Assistant Professor, Department of Philosophy, College of Charleston AND Robert
Sade, M.D.,Professor in the Department of Surgery and Director of the Institute of Human Values in Health Care,
Medical University of South Carolina. Kennedy Institute of Ethics Journal 12.1 (2002) 17-45
Paying for Kidneys: The Case against Prohibition http://muse.jhu.edu/journals/kennedy_institute_
of_ethics_journal/v012/12.1gill.html
First, we are arguing for the claim that it ought to be legal for a person to be paid for one of his or her
kidneys. We are not arguing that it ought to be legal for a potential recipient to buy a kidney in an
open market. We propose that the buyers of kidneys be the agencies in charge of kidney
procurement or transplantation; that is, we propose that such agencies should be allowed to use
financial incentives to acquire kidneys. We assume that allocation of kidneys will be based on
medical criteria, as in the existing allocation system for cadaveric organs. Kidneys will not be traded
in an unregulated market. 2 A similar system is currently in place for blood products: a person can
receive money for providing blood products, but one's chances of receiving blood are distinct from
one's financial status. We further note that transplant recipients or their agents—e.g., insurance
companies, Medicaid—pay for organs now, compensating the organ procurement organization that
organizes the organ retrieval, the surgeon who removes the organ, the hospital where the organ is
procured, and so forth. The only component of the organ procurement process not currently paid is
the most critical component, the possessor of the kidney, who is sine qua non for organ availability.
Second, we believe the legalization of kidney sales will increase the number of kidneys that are
transplanted each year and thus save the lives of people who would otherwise die. We base this
belief on two views that seem to us very plausible: first, that financial incentives will induce some
people to give up a kidney for transplantation who would otherwise not have done so; and second,
that the existence of financial incentives will not decrease significantly the current level of live kidney
donations. The first view seems to us to follow from the basic idea that people are more likely to do
something if they are going to get paid for it. The second view seems to us to follow from the fact
that a very large majority of live kidney donations occur between family members and the idea that
the motivation of a sister who donates a kidney to a brother, or a parent who donates a kidney to a
child, will not be altered by the existence of financial incentives. Although we think these views are
plausible, we acknowledge that there is no clear evidence that they are true. If subsequent research
were to establish that the legalization of kidney sales would lead to a decrease in the number of
kidneys that are transplanted each year, some of the arguments we make would be substantially
weakened. 3 Third, we are arguing for allowing payment to living kidney donors, but many of the
kidneys available for transplantation come from cadavers. [End Page 19] We believe that payment
for cadaveric organs also ought to be legalized, but we will not discuss that issue here. If we
successfully make the case for allowing payment to living donors, the case for payment for cadaveric
kidneys should follow easily. The Prima Facie Case for Kidney Sales With these preliminary points in
mind, we will proceed to the initial argument for permitting payment for kidneys. 4 This argument is
based on two claims: the "good donor claim" and the "sale of tissue claim." The good donor claim
contends that it is and ought to be legal for a living person to donate one of his or her kidneys to
someone else who needs a kidney in order to survive. These donations typically consist of someone
giving a kidney to a sibling, spouse, or child, but there are also cases of individuals donating to
strangers. Such donations account for about half of all kidney transplants. 5 Our society, moreover,
does not simply allow such live kidney donations. Rather, we actively praise and encourage them. 6
We typically take them to be morally unproblematic cases of saving a human life. The sale of tissue
claim contends that it is and ought to be legal for living persons to sell parts of their bodies. We can
sell such tissues as hair, sperm, and eggs, but the body parts we focus on here are blood products. A
kidney is more like blood products than other tissues because both are physical necessities: people
need them in order to survive. Our proposed kidney sales are more like the sale of blood products in
that both involve the market only in acquisition and not in allocation: the current system pays people
for plasma while continuing to distribute blood products without regard to patients' economic status,
just as we propose for kidneys. We do not typically praise people who sell their plasma as we do
people who donate a kidney to save the life of a sibling. At the same time, most people do not brand
commercial blood banks as moral abominations. We generally take them to be an acceptable means
of acquiring a resource that is needed to save lives. 7 It is doubtful, for instance, that there would be
widespread support for the abolition of payment for plasma if the result were a reduction in supply
so severe that thousands of people died every year for lack of blood products. If both the good donor
claim and the sale of tissue claim are true, we have at least an initial argument, or prima facie
grounds, for holding that payment for kidneys ought to be legal. The good donor claim implies that it
ought to be legal for a living person to decide to transfer one of his or [End Page 20] her kidneys to
someone else, while the sale of tissue claim implies that it ought to be legal for a living person to
decide to transfer part of his or her body to someone else for money. It thus seems initially plausible
to hold that the two claims together imply that it ought to be legal for a living person to decide to
transfer one of his or her kidneys to someone else for money. Of course, there seems to be an
obvious difference between donating a kidney and selling one: motive. Those who donate typically
are motivated by benevolence or altruism, while those who sell typically are motivated by monetary
self-interest. 8 The sale of tissue claim suggests, however, that this difference on its own is irrelevant
to the question of whether kidney sales ought to be legal, because the sale of tissue claim establishes
that it ought to be legal to transfer a body part in order to make money. If donating a kidney ought to
be legal (the good donor claim), and if the only difference between donating a kidney and selling one
is the motive of monetary self-interest, and if the motive of monetary self-interest does not on its
own warrant legal prohibition (the sale of tissue claim), then the morally relevant part of the analogy
between donating and selling should still obtain and we still have grounds for holding that selling
kidneys ought to be legal. There is also an obvious difference between selling a kidney and selling
plasma: the invasiveness of the procedure. Phlebotomy for sale of plasma is simple and quick, with
no lasting side effects, while parting with a kidney involves major surgery and living with only one
kidney thereafter. It is very unlikely, however, that there will be any long-term ill effects from the
surgery itself or from life with a single kidney. 9 Indeed, the laws allowing live kidney donations
presuppose that the risk to donors is very small and thus morally acceptable. The good donor claim
implies, then, that the invasiveness of the procedure of transferring a kidney is not in and of itself a
sufficient reason to legally prohibit live kidney transfer. If the only difference between selling plasma
and selling a kidney is the risk of the procedure, and if that risk does not constitute grounds for
prohibiting live kidney transfers, then the morally relevant part of the analogy between selling
plasma and selling a kidney still should obtain and we still have grounds for holding that kidney sales
ought to be legal. The point of the preceding two paragraphs is this: if we oppose the sale of kidneys
because we think it is too dangerous, then we also should oppose live kidney donations. But we do
not oppose live kidney donations because we realize that the risks are acceptably low and worth
taking [End Page 21] in order to save lives. So, it is inconsistent to oppose selling kidneys because of
the possible dangers while at the same time endorsing the good donor claim. Similarly, if we oppose
kidney sales because we think people should not sell body parts, then we should also oppose
commercial blood banks. But most people do not oppose blood banks because they realize that the
banks play an important role in saving lives. So, it is inconsistent to oppose selling kidneys because it
involves payment while at the same time endorsing the sale of tissue claim. 10 The considerable
emotional resistance to permitting kidney sales may be based on a combination of distaste for
payment and worry about risk. But if neither of these concerns on its own constitutes defensible
grounds for opposing payment, then it seems unlikely that the two of them together will do so. This
initial argument does not imply that we should legalize the sale of hearts and livers. The initial
argument holds only that, if it is medically safe for living people to donate an organ, then people
should also be allowed to sell that organ. But it is not medically safe for a living person to donate his
or her heart or liver. Our reliance on the good donor claim does, however, commit us to the idea that
if it is morally correct to allow someone to donate an organ or part of an organ, then it is morally
correct to allow someone to sell that organ or organ part. If, therefore, it is morally correct to allow
people to donate liver lobes and parts of lungs, then, according to our initial argument, it ought to be
legal for a person to sell a liver lobe or part of a lung as well. Our proposal does not address the
purchase of kidneys, which is a separate question. Many of the arguments against legalizing the
purchase of kidneys do not apply to the sale of kidneys. For example, one argument against
permitting the buying of kidneys is that it will lead to fewer kidneys for transplantation overall.
Another argument is that while allowing individuals to purchase kidneys might not reduce the overall
number of kidneys available for transplantation, it will reduce the number of donated kidneys and
harm the poor who will not be able to afford to buy a kidney. Both arguments rest on empirical
claims that are often stated as fact, yet have no supporting evidence. Even if the empirical claims
were accurate, moreover, their moral importance could be disputed. Perhaps there are powerful
moral reasons to legalize the buying of organs even if doing so leads to fewer organs overall or
reduces the chances of a poor person's receiving a kidney transplant. Then again, perhaps a negative
effect on the overall supply of kidneys or on the transplantation prospects [End Page 22] for the poor
will turn out to be a conclusive reason not to legalize the buying of kidneys. The important point is
that our proposal will not be affected either way. As already noted in our preliminary points, our
proposal can be reasonably expected both to increase the overall number of kidneys for
transplantation and to increase the chances that a poor person who needs a kidney will receive one.
Therefore, in arguing for the legalization of kidney sales, we put aside the separate question of
whether buying kidneys ought to be legal as well.
Review of literature concludes that sales will increase supply
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
On balance, a fair-minded reading of the evidence suggests that compensation for donors, if
done correctly and sensibly, would increase, probably substantially, the number of organs
available for transplant. In the cases of both deceased donors (and their families) and living
donors, available evidence confirms the observation that people respond to incentives.
Empirically, sales would not be primarily from the poor. All income groups would
participate.
Halpern 10 Scott D. Halpern, MD, PhD, MBioethics, Amelie Raz, Rachel Kohn, BA, Michael Rey,
BA, David A. Asch, MD, MBA, and Peter Reese, MD, MSCE, University of Pennsylvania School of
Medicine and Philadelphia Veterans Affairs Medical Center, Ann Intern Med. 2010 Mar 16; 152(6):
358–365. Regulated Payments for Living Kidney Donation: An Empirical Assessment of the Ethical
Concerns
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865248/?report=classic%5Dab
Unjust Inducement
Higher payments increased the probabilities of donating but did so evenly across the 6 income strata,
such that no evidence of an interaction between payment and income was found (OR, 1.01 [CI, 0.99 to
1.03]) (Figure 3). Even when we restricted analyses to the 57 participants in the lowest income stratum
(annual household income ≤$20 000) and the 66 participants in the highest income stratum (annual
household income >$100 000), no significant interaction emerged (OR, 0.99 [CI, 0.97 to 1.02])
(Figure 3). Among participants in the lowest income stratum, conditionally adjusted donation rates
were 29.8% (CI, 19.5% to 42.7%) for $0, 44.1% (CI, 33.1% to 55.7%) for $10 000, and 47.9% (CI,
36.4% to 59.6%) for $100 000. Among participants in the highest income stratum, the rates were
15.2% (CI, 9.0% to 24.5%), 27.5% (CI, 18.8% to 38.2%), and 31.3% (CI, 21.7% to 42.9%),
respectively. These results suggest that payment is not an unjust inducement for living kidney
donation.
Coercion of the poor does not apply to central purchasing –egg donations prove
Sobota 4 Margaret R. Sobota, J.D. Candidate (2005), Washington University School of Law. Washington
University Law Quarterly Fall, 2004 82 Wash. U. L. Q. 1225 NOTE: THE PRICE OF LIFE: $ 50,000 FOR AN EGG, WHY NOT
$ 1,500 FOR A KIDNEY? AN ARGUMENT TO ESTABLISH A MARKET FOR ORGAN PROCUREMENT SIMILAR TO THE CURRENT
MARKET FOR HUMAN EGG PROCUREMENT lexis
A. Arguments Opposing a Market for Organ Procurement
The main argument against establishing a market for organ procurement is economic coercion. n141
Market opponents insist that poor, destitute people from around the world will be forced into selling
their organs without making an in-formed decision. n142 There are several flaws with this argument.
n143 First, the economic coercion argument is based on the false premise that the prices donors will
be paid for their organs will be high enough to override their doubts and ethical concerns about
becoming a donor. n144 In the proposed market system for organ procurement, either OPOs or the
state will be paying the donors; thus preventing potential wealthy recipients from driving up the
prices paid for organs. n145 With only moderate prices being paid to organ donors, economic
incentives would likely not outweigh a donor's moral objections to donation, and thus no economic
coercion would occur. n146 Additionally, the current market system for egg donation suggests that
economic coercion would not be a problem in a market for organ procurement. n147 A majority of
egg donors are not poor or minority women, and the amounts paid to them for their donations are
usually not an "undue inducement to undergo the medical [*1246] risks involved." n148 These facts
suggest that if a system of financial compensation for organ donation were established, comparable
to the system already in place for egg donation, there would similarly be no economic coercion of
donors.
Contention 4 is risk calculus
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,
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
33 percent of young African American men (Prison Watch 2002). In the end
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).
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
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
Asian dictatorships. Overall, the autocratic revivalists paint
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 hegemonic relationships that
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
require them to give something in return. Also unlike in the nineteenth century, today the
of the most plausible cases of a future interstate war, would pose for the Chinese communist regime daunting 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
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
which they could reasonably expect to translate their growing clout into geopolitical changes that would benefit themselves. But
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
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
large and growing social networks across international borders.
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,
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
acting like a satisfied status quo state.
from industrialism and economic globalization that will create common interests across states regardless of regime type. Autocratic China is as dependent on
, India, Japan, and the United States, suggesting an alignment of interests against petroleumexporting autocracies, such as Iran and Russia. These states share a common interest in price stability and supply security that
imported oil as are democratic Europe
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
and 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.
international transactions and institutions,
Prefer the affirmative’s impacts to highly specific long term disadvantages – cognitive
bias means you will think their impact is better than it really is
Yudkowsky 06 [Eliezer, 8/31/2006. Singularity Institute for Artificial Intelligence Palo Alto, CA.
“Cognitive biases potentially affecting judgment of global risks, Forthcoming in Global Catastrophic
Risks, eds. Nick Bostrom and Milan Cirkovic, singinst.org/upload/cognitive-biases.pdf.
The conjunction fallacy similarly applies to futurological forecasts.
Two independent sets of professional analysts at the
Second International Congress on Forecasting were asked to rate, respectively, the probability of "A complete suspension of diplomatic relations
between the USA and the Soviet Union, sometime in 1983" or "A Russian invasion of Poland, and a complete suspension of diplomatic relations
between the USA and the Soviet Union, sometime in 1983". The second set of analysts responded with significantly higher probabilities.
(Tversky and Kahneman 1983.)
In Johnson et. al. (1993), MBA students at Wharton were scheduled to travel to Bangkok as part of their degree program. Several groups of
students were asked how much they - 6 - were willing to pay for terrorism insurance. One group of subjects was asked how much they were
willing to pay for terrorism insurance covering the flight from Thailand to the US. A second group of subjects was asked how much they were
willing to pay for terrorism insurance covering the round-trip flight. A third group was asked how much they were willing to pay for terrorism
insurance that covered the complete trip to Thailand. These three groups responded with average willingness to pay of $17.19, $13.90, and
$7.44 respectively.
According to probability theory, adding additional detail onto a story must render the story less probable.
It is less probable that Linda is a feminist bank teller than that she is a bank teller, since all feminist bank tellers are necessarily bank tellers.
Yet human psychology seems to follow the rule that adding an additional detail can make the story more
plausible.
People might pay more for international diplomacy intended to prevent nanotechnological warfare by China, than for an engineering project to
defend against nanotechnological attack from any source. The second threat scenario is less vivid and alarming, but the defense is more useful
because it is more vague. More valuable still would be strategies which make humanity harder to extinguish without being specific to
nanotechnologic threats - such as colonizing space, or see Yudkowsky (this volume) on AI. Security expert Bruce Schneier observed (both
before and after the 2005 hurricane in New Orleans) that the U.S. government was guarding specific domestic targets against "movie-plot
scenarios" of terrorism, at the cost of taking away resources from emergency-response capabilities that could respond to any disaster. (Schneier
2005.)
Overly detailed reassurances can also create false perceptions of safety:
"X is not an existential risk and you
don't need to worry about it, because A, B, C, D, and E"; where the failure of any one of propositions A, B, C, D, or E potentially extinguishes
the human species. "We don't need to worry about nanotechnologic war, because a UN commission will initially develop the technology and
prevent its proliferation until such time as an active shield is developed, capable of defending against all accidental and malicious outbreaks that
Vivid, specific scenarios can
inflate our probability estimates of security, as well as misdirecting defensive investments into needlessly
narrow or implausibly detailed risk scenarios.
contemporary nanotechnology is capable of producing, and this condition will persist indefinitely."
More generally, people tend to overestimate conjunctive probabilities and underestimate disjunctive
probabilities. (Tversky and Kahneman 1974.) That is, people tend to overestimate the probability that, e.g., seven
events of 90% probability will all occur. Conversely, people tend to underestimate the probability that at
least one of seven events of 10% probability will occur. Someone judging whether to, e.g., incorporate a new startup, must
evaluate the probability that many individual events will all go right (there will be sufficient funding, competent employees, customers will want
the product) while also considering the likelihood that at least one critical failure will occur (the bank refuses - 7 - a loan, the biggest project
fails, the lead scientist dies). This may help explain why only 44% of entrepreneurial ventures3 survive after 4 years. (Knaup 2005.)
Low probability impacts should not be evaluated-- even if there’s some risk, policy
decisions can’t be justified by vanishingly small probabilities
Rescher 03 (Nicholas, Prof of Philosophy at the University of Pittsburgh, Sensible Decisions: Issues of Rational Decision in Personal Choice
and Public Policy, p. 49-50)
On this issue there is a systemic disagreement between probabilists working on theory-oriented issues in mathematics or natural science and
decision theorists who work on practical decision-oriented issues relating to human affairs. The former takes the line that small number are small
numbers and must be taken into account as such—that is, the small quantities they actually are. The latter tend to take the view that small
probabilities represent extremely remote prospect and can be written off.
(De minimis non curat lex, as the
old precept has it: in human affairs there is no need to bother with trifles.) When something is about as probable as a thousand fair dice when
tossed a thousand times coming up all sixes, then, so it is held, we
can pretty well forget about it as a worthy of concern. As a
matter of practical policy, we operate with probabilities on the principle that when x ≤ E, then x = 0. We take the line that in
our human dealings in real-life situations a sufficiently remote possibility can—for all sensible purposes—be
viewed as being of probability zero. Accordingly, such remote possibilities can simply be dismissed,
and the outcomes with which they are associated can accordingly be set aside. And in “the real
world” people do in fact seem to be prepared to treat certain probabilities as effectively zero, taking
certain sufficiently improbable eventualities as no long representing real possibilities. Here an extremely
improbable event is seen as something we can simply write off as being outside the range of appropriate concern, something we can dismiss for
all practical purposes. As one writer on insurance puts it: [ P]eople…refuse
to worry about losses whose probability is
below some threshold. Probabilities below the threshold are treated as though they were zero. No doubt,
remote-possibility events having such a minute possibility can happen in some sense of the term, but this
“can” functions somewhat figuratively—it is no longer seen as something that presents a realistic
prospect.
Evaluating risk with a one percent doctrine makes life impossible – everything could
theoretically cause extinction
Meskill 09 (David, professor at Colorado School of Mines and PhD from Harvard, “The "One Percent Doctrine" and Environmental Faith,”
Dec 9, http://davidmeskill.blogspot.com/2009/12/one-percent-doctrine-and-environmental.html)
Tom Friedman's
piece today in the Times on the environment (http://www.nytimes.com/2009/12/09/opinion/09friedman.html?_r=1) is one of the flimsiest
Cheney's "one percent doctrine" (which is similar to the
environmentalists' "precautionary principle") to the risk of environmental armageddon. But this doctrine is both
intellectually incoherent and practically irrelevant. It is intellectually incoherent because it cannot be applied
consistently in a world with many potential disaster scenarios. In addition to the global-warming risk,
there's also the asteroid-hitting-the-earth risk, the terrorists-with-nuclear-weapons risk (Cheney's original scenario),
the super-duper-pandemic risk, etc. Since each of these risks, on the "one percent doctrine," would
deserve all of our attention, we cannot address all of them simultaneously. That is, even within the onepercent mentality, we'd have to begin prioritizing, making choices and trade-offs. But why then should we only make
these trade-offs between responses to disaster scenarios? Why not also choose between them and other, much more cotidien, things we
value? Why treat the unlikely but cataclysmic event as somehow fundamentally different, something that cannot be
integrated into all the other calculations we make? And in fact, this is how we behave all the time. We get into our cars in order
to buy a cup of coffee, even though there's some chance we will be killed on the way to the coffee shop.
We are constantly risking death, if slightly, in order to pursue the things we value. Any creature that
adopted the "precautionary principle" would sit at home - no, not even there, since there is some chance the building might collapse. That
creature would neither be able to act, nor not act, since it would nowhere discover perfect safety . Friedman's
pieces by a major columnist that I can remember ever reading. He applies
approach reminds me somehow of Pascal's wager - quasi-religious faith masquerading as rational deliberation (as Hans Albert has pointed out, Pascal's wager itself
doesn't add up: there may be a God, in fact, but it may turn out that He dislikes, and even damns, people who believe in him because they've calculated it's in their best
interest to do so). As my friend James points out, it's
striking how descriptions of the environmental risk always describe
the situation as if it were five to midnight. It must be near midnight, since otherwise there would be no
need to act. But it can never be five *past* midnight, since then acting would be pointless and we might
as well party like it was 2099. Many religious movements - for example the early Jesus movement - have exhibited
precisely this combination of traits: the looming apocalypse, with the time (just barely) to take action.