1NC
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The word “legalize” in the plan is vague
Boire 95 - Richard Glen Boire holds a Doctorate of Jurisprudence from the University of California Berkeley's Boalt Hall School
of Law. (Entheogen Law Reporter - quarterly newsletter produced by attorney Richard Glen Boire in the 1990s, Issue 7,
https://www.erowid.org/library/periodicals/journals/telr/telr_7.pdf)
On the date of his speech, Solomon introduced HR 1453 which would amend the federal tax code to deny tax exempt status to any
organization "if any portion of the activities of such organization consists of promoting the legalization of any controlled substance." I
have long argued that the term "legalization" means very different things to different people, and' hence is
vague to the point of being incomprehensible absent specific details of the plan. What is not unclear,
however, is Solomon's intent to censure those with opposing viewpoints.
So is ‘the United States’
McFerran 5 - began his career working as a feature writer and contributing editor for the New American, a journal committed
to topics of social, political, and economic interests. He has published numerous articles on historical events, politics, and current
affairs and served as the national director of Tax Reform Immediately (TRIM). Dedicated to the American dream of prosperity,
McFerran writes to generate increased awareness and appreciation for the Constitution of the United States
(Warren, “Political Sovereignty: The Supreme Authority in the United States,” p. 147)
True, Calhoun conceded, the Preamble of (he Constitution reads that "We the people of the United States" ordain and establish the
new government. But this phrase proves nothing, he said. The term "United States" had been used earlier to
designate the thirteen States in Congress assembled, even though the Articles of Confederation specifically recognized
the sovereignty of the separate States. Here was a mere problem of semantics, Calhoun thought (though, of course, he did not use
that word; it had not yet been invented). The phrase "the people of the United States" could be ambiguous,
for it was sometimes used in a territorial or geographical sense. "In this sense, the people of the United States
may mean all the people living within these limits, without reference to the States or Territories in which they may reside, or of which
they may be citizens," Calhoun admitted. But he said the phrase, in its political sense, refers to "the States
united, which in- version alone, without further explanation, removes the ambiguity." There was, strictly speaking, no United
States. There were only the States United.
Vote neg – Absent specification, the range of definitions is infinite – it’s key to
neg strategy – otherwise the aff can shift against DAs and permute all
counterplans – we need to be able to impact turn strategies of legalization
OFF
Counterplan: The United States should legalize and implement a uniform, federal,
refundable tax credit, regardless of income, for nearly all donation of human
organs.
Organs sales provoke backlash- tax credits for donation are distinct, solve the
aff, avoid backlash, and accommodate altruism
Clamon, 8 -- clerk for Judge Melloy of the US Court of Appeals for the Eighth Circuit
[Joseph, J.D. University of Iowa, he has held adjunct professorships in the Drake University Law School and Drake University
College of Pharmacy and Health Sciences, as well as serving as an instructor at the Northwestern University School of Law, "Tax
Policy as a Lifeline: Encouraging Blood and Organ Donation Through Tax Credits," Annals of Health Law, Winter 2008, 17 Ann.
Health L. 67, l/n, accessed 8-31-14]
IV. Possible Tax Policy Alternatives
An alternative to compensation or noncommercial systems, which raise serious ethical and practical concerns, is the
use of tax policy to encourage blood and organ donation. As Parker and Winslade state in their article Tax Policy
and the Blood Supply in which they advocate of the use of a charitable deduction for blood donations: Tax incentives would
enhance a potential donor's willingness to give by reflecting the value society ascribes to the gift
rather than by creating an economic incentive in and of itself ... [the tax incentive would be] only
a simple acknowledgement of generosity, a gesture of appreciation, or a token of esteem - not a
financial incentive or reward. n191 This type of favorable tax treatment would accomplish four important
objectives: "(1) provide an incentive designed to stimulate corporate sponsorship of blood drives; n192 (2) in some manner
recognize the generosity of blood donors; (3) protect the safety of the blood supply; and (4) accommodate established
ethical norms." n193 To accomplish these goals, donations could be encouraged either by permitting a charitable deduction for donating either blood or organs or providing a tax credit. This
section will explore both options, and explain why the tax credit is the stronger proposal. A. Offering a Charitable Deduction for Donations Allowing taxpayers to take a charitable deduction for donations of blood
or organs offers numerous advantages. First, it would preserve the altruistic nature of donation. n194 Second, "it would not conflict with the ethical proscription against the exploitation of disadvantaged groups."
n195 Because the tax structure is progressive in nature, the value of the deduction would become greater the more income earned by the taxpayer, and conversely, its value would diminish the less income
earned by the taxpayer. n196 At the lower levels of the income scale the deduction would be "swallowed" by [*91] the personal exemption and standard deduction. n197 A charitable deduction would not serve as
a disproportionate incentive to the poor, but rather, using a charitable deduction might actually "unfairly deprive the less affluent donor of a benefit." n198 Third, it is unlikely that the tax incentive poses as
significant threat to the safety of the blood supply as would a direct cash payment. n199 Fourth, a tax incentive would not produce an inequitable allocation of organs, but rather would preserve the current
allocation system under UNOS. n200 Fifth, offering a charitable deduction would not undermine the basic ethics and morality that underlie the current foundation of our donation system. n201 Despite all of these
advantages, implementing a charitable deduction for donation would require significant alterations to the tax code and would pose daunting administrative challenges. The tax code does not consider the human
body to be property and does not permit deductions for contributions of services. n202 To allow a deduction, the IRS would have to allow deductions for contributions of services or classify the human body as
property. Either change would be a significant policy shift. If the body were to be considered property, the IRS would face many complicating issues, including: (1) whether "during life or upon death, [a person]
could actually generate ... additional income, gift, or estate tax liability"; n203 (2) how to determine the fair market value of the human body, organs, and blood; (3) whether blood or organs constitute a long-term
capital gain; (4) the basis in a human body; and (5) whether some blood and organs are worth more than others. n204 These questions are complex and controversial. A strict interpretation of the tax code would
not make a distinction between a taxpayer who donates blood or an organ and any other commercial activity. n205 "For example, the Tax Court has found that income derived from the sale of blood plasma [*92]
is conceptually the same as that generated by the sale of any other product, without regard to "the sanctity of the human body.'" n206 Thus, "the excess of the fair market value of [blood or organs] received over
the cost or other basis" of the transferred blood or organ constitutes taxable income. n207 If it is taxable income, fair market value would have to be determined. Courts have held that fair market value is "the price
at which property would change hands between a willing buyer and a willing seller, neither being under any compulsion to buy or to sell..." n208 Applying this notion to the human body is exceptionally complex.
Parker and Winslade state, "the very idea that a "willing' buyer could act without "compulsion' in a contract involving the exchange of a life-giving thing is an anomaly of thought." n209 Furthermore, as discussed
in Sections II.A.2.d and e, "the law precludes the existence of a legitimate market in which buyers and sellers may trade in these "goods' ... ." n210 This fact does not "render them without value, as the market in
illicit drugs so readily attests," but it does make valuation difficult and would likely prompt substantial debate and increase the possibility of costly litigation. n211 To provide a charitable deduction for donation it
would also be necessary to determine the basis in a human body. n212 Parker and Winslade explain that: Because we do not purchase our bodies or otherwise acquire them in a transaction from which we can
derive any identifiable cost, it would appear that we have a basis of zero in these, our most physical of assets. Accordingly, a participant in [an organ] exchange would realize income in an amount equal to the full
value of the organ received, which could be significant. n213 If the basis is not zero, would the basis in all bodies be equal? Since the fair market value of the donated organ or blood would have to be determined,
would the blood or organ of a younger person be worth more than that of an older person? Would the blood or organ of a healthy person be worth more than that of a person who engaged in "unhealthy" activities
such as smoking or drinking? Would someone whose blood type is O, the most common blood type, be worth more or less than type AB, the least [*93] common type? n214 How would such values be
substantiated? These are just a few of many difficult questions that are created by such a system. A charitable deduction for donation also has implications for the gift and estate tax provisions in the tax code.
n215 The IRS General Counsel stated: If blood is property, then any part of the human body is property. Gift tax is imposed ... on the transfer of property by gift. If any part of the body is property then a gift tax
should be levied on the gift of a kidney for transplant if it is not given through a charitable organization. Likewise, a taxpayer's estate includes the value of all property in which he had an interest at death. The
value of a decedent's body should therefore be includible in his estate. In today's world where transplants take place daily, these issues are not illusory. n216 Finally, the current tax code requires that a charitable
deduction be made ""to or for the use of' a qualified charitable organization." n217 The IRS would likely have to either alter or clarify this regulation as well. Accordingly, the tax code would have to be significantly
amended to provide a charitable deduction for blood or organ donation. Implementing a charitable deduction poses other administrative challenges. One administrative challenge, especially for blood donors, is
that donors would be subject to "the same substantiation requirements imposed on taxpayers who claim deductions for other forms of charitable contributions." n218 Another administrative obstacle is that current
FDA regulations require that blood be labeled as having been collected from either paid or volunteer donors. n219 Permitting a charitable deduction would likely require either an alteration or clarification of these
FDA rules. Accordingly, there are administrative obstacles in addition to tax law issues that would encumber implementation of a charitable deduction for blood or organ donation. B. Granting a Tax Credit for
The creation of a tax credit for donations is a less administratively complex means of
reaching the same objectives without opening the Pandora's Box of deciding whether the human
body is property and how to [*94] determine the fair market value of a donor's blood and organs. Under
this proposal, a person would receive a tax credit for agreeing to be a donor. n220 The tax credit system offers the same
advantages as the charitable deduction, but does not require the IRS to change its interpretation that the
human body is not property. Further, the tax credit would not require any fair market value analysis of
blood or organs. The credit would also preserve the altruistic nature of the donation and would not
exploit the disadvantaged. n221 Additionally, a tax credit, like the deduction system, would not pose a threat to the safety
of the blood supply and would not produce an inequitable allocation of organs. Similar to the charitable deduction, a tax credit
would not undermine the basic ethics and morality that underlie the foundation of the current
Donations
donation system. As with almost all of the proposals made to date, the tax credit would incur the same substantiation
problems, FDA regulation issues, and the question regarding the "to or for the use of" requirement as the charitable deduction. Yet,
unlike the charitable deduction, a tax credit would not force significant changes to be made to the rest of the tax code. The IRS
would not have to choose whether to allow deductions for services or classify the body as property. This problem is not created by a
credit. A tax credit does not raise sensitive questions regarding the fair market value of body parts and fluids, or whether some
people's organs and blood are worth more than another person's blood or organs. People would neither have to claim their bodies
as assets upon their death nor would they have to determine their basis. Thus, a tax credit offers the same benefits as the charitable
deduction without the statutory consistency problems created by a deduction. A tax credit creates an incentive to
attract potential donors without creating a commercial market , changing the donation system to an "opt out" approach, defining the body
as property, or imposing any other significant policy choices. In almost all of the literature on methods of encouraging organ donation, five main concerns are consistently raised: (1) destroying the benefits of
altruism; (2) coercion of the poor; (3) inequitable allocation of organs; (4) creating family conflict; and (5) concerns of basic morality. n222 A tax credit for blood and organ donation does not raise any of these
concerns, but rather protects the values they espouse. [*95] Moreover, the tax credit proposed would attain at least three of the four objectives set forth by Parker and Winslade in their charitable deduction
proposal: (1) recognizing the generosity of donors; (2) not endangering the safety of the blood supply; and (3) accommodating established ethical norms. n223 The fourth objective, encouraging corporate
sponsorship of blood drives, n224 could easily be accomplished by creating a provision in the proposed tax credit statute offering corporations a tax credit for organizing blood drives. n225 Similar to the individual
incentive in the model statute in this article, which gives incentives for donating more than once, the credit could increase for each additional blood drive, up to a defined limit. Two issues that must be addressed
to use a tax credit to encourage blood and organ donation are whether the tax credit should be refundable or nonrefundable and when the taxable event is realized and recognized such that the taxpayer may
obtain the tax credit. Parker and Winslade propose the use of a refundable tax credit, which can reduce one's tax liability below zero. n226 "[A] refundable credit is applied first to reduce or eliminate one's tax
liability, with any unused amount being paid out to the taxpayer in cash; the amount of any credit in excess of the recipient's tax liability would, in effect, represent a government subsidy to him." n227 A refundable
tax credit would therefore not only cause the federal government to lose essential tax revenue, but would also force the government to spend money that could otherwise be allocated to address other significant
public policy issues. Refundable tax credits are typically used only in circumstances where the government wishes to allocate money to achieve a fundamental societal objective, for example the earned income
tax credit is intended to assist the poor. n228 Taking into consideration the economic implications of a refundable tax credit, in particular its impact on the availability of government resources for other public policy
priorities, this article proposes the use of a nonrefundable tax credit, which would not permit taxpayers to receive a refund if their tax owed was reduced below zero. This type of credit would attain the objective of
encouraging donation, but would not financially overburden the government. Blood and organ donation could effectively be encouraged through the use of a nonrefundable tax credit without requiring [*96] the
government to spend money that could be used for other public policy purposes. Further, if empirical data demonstrates after several years that the nonrefundable tax credit provides insufficient incentive, the tax
credit could be transformed into a refundable tax credit if necessary. The second issue concerning the timing of when the taxable event is realized and recognized has significant implications for organ donation.
Should a person realize and recognize the tax credit when he or she pledges to donate blood or organs? Or should it be when a person actually makes the donation? For example, if a person promises to donate
her organs at the time of death when she is twenty-five and she dies at eighty-five, may she obtain the benefit of the tax credit at twenty-five or at the time of her death? This issue is not as significant for blood
donation, because blood donation can generally occur immediately within a given fiscal year in which the taxpayer seeks the tax credit. Parker and Winslade propose a refundable tax credit that is realized and
recognized at the time when the taxpayer agrees to donate his organs irrespective of when death occurs. n229 This article proposes the use of a tax credit that must be realized and recognized at the moment of
donation, not upon a promise of future donation because it achieves the stated objective of encouraging donation while avoiding potential conflict that might arise under a system in which persons could take the
tax credit prior to actual donation. The IRS does not treat a contribution as permanently set aside unless the chance that the contribution will not be applied to the donor's intended charitable purpose is so remote
that it is negligible. n230 As discussed earlier, the chance that a potential organ donor's contribution will not be applied is not remote, but rather substantial n231 Parker and Winslade intelligently suggest that a
database, akin to the National Practitioner Data Bank, could be used to document a taxpayer's promise to donate and that such a promise would thereafter make donation mandatory. n232 Further, Parker and
Winslade pragmatically suggest immunizing providers from liability when they rely in good faith on the database when retrieving organs. n233 These solutions, though beneficial, are insufficient. Given the history
of conflict over donative intent, disputes between family members regarding organ donation, and questions of capacity of the donor, substantial controversy and costly litigation is likely [*97] to arise under such a
system. This conflict is avoidable if the tax credit is permitted only at the time of donation. As discussed above, this position is consistent with current IRS guidance. n234 Thus, a nonrefundable tax credit realized
and recognized at the time of giving is a unique vehicle through which blood and organ donation can be encouraged, while guarding against the hazards of a commercial system and maintaining the current tax
treatment of charitable giving and the human body. The following are two model statutes that offer guidance as to how a nonrefundable tax credit section in the tax code might operate. These statutes are by no
means the only way a tax credit could work. They are intended to be but one example of how donation could be encouraged through the use of a nonrefundable tax credit. § XXX. Qualified Blood Donation
Programs (a) Allowance of credit. (1) In general. - There shall be allowed as a credit against the tax imposed by this chapter for the taxable year with respect to each qualifying donation of blood products by the
taxpayer an amount equal to the per donation amount. (2) Per donation amount - For the purposes of paragraph (1), the per donation amount shall be determined as follows: In the case of any taxable year in
which the The per donation amount taxpayer donated blood products: is - Once in the taxable year $ 500 Twice in the taxable year $ 1000 Three to six times in the taxable year n235 $ 2000 (b) Limitation based
on adjusted gross income - (1) In general - The amount of the credit allowable under subsection (a) shall be reduced (but not below zero) by $ 50 for each $ 1000 (or fraction thereof) by which the taxpayer's
adjusted gross income exceeds the threshold amount. (2) Threshold amount. - For purposes of paragraph (1), the term "threshold amount" means - (A) $ 110,000 in the case of a joint return [*98] (B) $ 75,000 in
the case of an unmarried individual, and (C) $ 55,000 in the case of a married individual filing a separate return. (c) Qualifying blood product donation - For purposes of this section - (1) In general - The term
"qualifying blood production donation" means any donation of: (A) Blood products derived from human blood used for purposes of transfusion into another person or for federally-approved biomedical research. (B)
Any other products formulated via removal of human blood used for purposes of transfusion into another person or for federally-approved biomedical research. (d) Blood products - For purposes of this section (1) In general. The term "blood products" shall include human blood of any type, red blood cells, white blood cells, platelets, plasma, and any other federally-approved blood-derived product that may be legally
donated under the National Organ Transplant Act. (2) Sperm, ova, and hair are not covered by this section. n236 (e) Donation to self exception - (1) In general. The term "qualifying blood product donation" shall
not include the removal of human blood from one individual and replacement of that blood into the same individual at the same or a later time. § XXX. Qualified Organ Donation Programs (a) Allowance of credit. (1) In general. - There shall be allowed as a credit against the tax imposed by this chapter for the taxable year with respect to each qualifying human organ donation(s) by the taxpayer an amount equal to the per
donation amount. (2) Per donation amount - For the purposes of paragraph (1), the per donation amount shall be- (A) $ 5,000 for the donation of at least one human organ to either another individual or
individuals, a medical center for donation to an unspecified person(s), to the cause of science. (B) $ 10,000 for the donation of all of the taxpayer's organs to either another individual or individuals, a medical
center for donation to unspecified person(s), to the cause of science. [*99] (b) Limitation based on adjusted gross income - (1) There shall be no limit on the amount of credit allowable under subsection (a) based
on adjusted gross income. (c) Qualifying organ donation(s) - For purposes of this section - (1) In general - The term "qualifying organ donation(s)" means any donation of: (A) A part or structure of the human
anatomy adapted for the purpose of some specific function or functions. (B) Sperm, ova, and hair are not covered by this section. n237 (d) Donation to self exception - (1) In general. The term "qualifying organ
donation" shall not include the removal of human organ(s) from one individual and replacement of the organ(s) into the same individual at the same or a later time. V. Conclusion The demand for blood and human
organs will continue to grow as society's ability to save and improve lives by transplanting more parts of the body increases. To have any chance of meeting the ever-increasing level of demand for blood and
organs, the current donation system must be modified to encourage donation in order to substantially increase the quantity of available healthy, compatible blood and organs. Some individuals, such as pure
Some may be attracted to a direct
compensation system, but many people vehemently object to such an outright offer of
remuneration. n239 A reasonable alternative is the use of a tax credit as an incentive to "attract the
attention of those potential donors who wouldn't be willing to sell their blood in a purely commercial
transaction" but who would accept favorable tax treatment as a "token of public appreciation of
their generosity." n240 It may even "arouse existing but dormant inclinations toward altruism." n241
For these reasons, tax credits are an effective, ethically acceptable, and perhaps even ethically preferable means
of encouraging blood and organ donation.
altruists, "would donate without any external stimulus," n238 while others would never donate regardless of the incentives offered.
OFF
Obama’s veto of Keystone sustained now—need to keep Dems in line to sustain
Robert Spendlove, Economic & Public Police Officer, Zions Bank, “Treanding in DC—The Politics of the Keystone XL
Pipeline,” UTAH PULSE, 1—21—15, http://utahpulse.com/index.php/features/business/1698-trending-in-d-c-the-politics-of-thekeystone-xl-pipeline
Interestingly, with the new Republican majority in the Senate, it seems that there will be enough votes to past the bill,
but probably not with a veto-proof super-majority. The Senate took a test vote on the bill recently, when Senators
voted 63-32 to begin debate. In the past, President Obama has stated that he will veto the bill if it passes, and he
reiterated that threat recently. The debate over the Keystone Pipeline is shaping up to be a proxy over how McConnell will run the
Senate in the 114th Congress. He has stated that he would allow opportunity for amendments as the bill is considered in the
Senate. He also has said that he would like to return the Senate to “regular order,” meaning that bills will go through the typical
process of committee hearings rather than being actively managed by majority leadership. However, restoring regular order and
allowing amendments to bills results in a weakening of the power of leadership and it could end up slowing down or even derailing
the bill altogether. Amendments can also result in changes to the overall policy objectives of legislation. Amendments may define
the Republican’s energy wish-list for the next two years, but could erode the bi-partisan support the proposal has enjoyed in the
past. If faced with the prospect of his very first legislative priority struggling in his body, Senator McConnell may decide to start
leaning away from regular order in favor of active management and more surety in accomplishing his objectives. Whether or not
Congress is able to pass legislation, this is going to be a challenging decision for President Obama as well. His veto threat is
more about Congressional overstepping than his position on whether to build the pipeline. His support base is
split on whether to approve the pipeline. There is no safe path on this for the President.
Plan guts political capital
Steve Calandrillo, University of Washington, “Cash for Kidneys? Utilizing Incentives to nd America’s Organ Shortage,”
GEORGE MASON LAW REVIEW v. 13, 2004, LN.
legalized human organ market would be far from a utopian solution: it would
be political suicide to propose, entail significant administrative costs to establish and monitor, and
remain morally distasteful to many Americans. While such markets havebeen debated without much progress in the
Despite the above analysis, any form of
past, far less attention has been paid to dozens of other monetary and nonmonetary incentives that could be employed. Taking an
incentive-based approach would avoid imposing risk on living donors, dramatically expand the pool of available organs, and shock
the conscience far less than allowing living-seller markets.190
Capital key to unity, sustaining the veto—assumes their thumpers
Sink, 12-19 -- The Hill White House correspondent
[Justin, "Obama seeks to prolong power," The Hill, ,thehill.com/homenews/administration/227628-obama-seeks-to-prolong-power,
accessed 12-30-14]
Obama seeks to prolong power
The last month has provided a glimpse of how President Obama plans to maintain his relevance in Washington while facing lame-duck status and a
Republican House and Senate. Wednesday’s surprise announcement that the U.S. was seeking to normalize relations with Cuba was the latest
example of a new, muscular approach on executive action that has highlighted how Obama can enact change without Congress, while enlivening a
dispirited liberal base. It followed Obama’s quiet signing of a $1.1 trillion spending package negotiated with Republican congressional leaders that
angered liberals — and that provoked a rare rift with House Democratic Leader Nancy Pelosi (D-Calif.). To get the government-funding bill past the
finish line, Obama sent his White House chief of staff to Capitol Hill to calm restive Democrats, and made last minute calls to allies such as Rep. James
Clyburn (D-S.C.), the third-ranking Democratic leader in the House, to secure its passage. Both the executive actions and negotiations with
Republicans are a sign of things to come for a White House that seemed to be playing defense for most of 2013 and 2014. And the moves come after
a disastrous midterm election that saw the GOP gain the Senate majority as well as seats in the House. The election gives Republicans more power in
Washington at a time when Obama’s influence over his own party weakened. Yet the White House is signaling with its actions that it is far from willing
to give away the spotlight. “He’s made it pretty clear he’s not shrinking away,” said Democratic strategist Steve Elmendorf. The growing sense of
momentum, coupled with the sense that the president has many avenues — and newfound freedom — has the administration confident Obama can
continue to exert his relevance. White House press secretary Josh Earnest said Thursday that Obama was “pleased with the kind of progress that we
have made” over the past few weeks, and that the White House had “accomplished” its goal of making 2014 a “year of action.” “But there is a lot more
that needs to get done, and the president has a long list of things that he is looking forward to tackling in the new year,” Earnest said. The White House
believes Obama’s unilateral moves won’t undermine his ability to strike bipartisan compromises on shared priorities with Republicans, especially on
issues like trade and infrastructure. While getting deals on either would be a challenge under any circumstance, the president believes such
compromises could be achievable as part of a package including corporate tax reform. And Obama's
success in winning over
members of his caucus on the funding bill underscored that he can still effectively twist Democratic
arms toward his policy priorities. That leverage will be crucial headed into a series of deadlines for must-pass legislative
business, including securing funding for the Department of Homeland Security, raising the debt ceiling, and renewing the charter for the
Export-Import bank. “There are a whole bunch of these speed bumps that will really require the administration to thread the needle,”
said Jim Manley, a former aide toSenate Majority Leader Harry Reid (D-Nev.). And the White House appears confident that it
can maintain sway on the left, despite the recent fissures. While progressives felt betrayed by provisions in the spending
bill that rolled back rules included in the Wall Street reform bill, they are elated over the Cuba news. And the White House has other recent victories
that it sees as building a reservoir of support with progressives. Obama’s support for net neutrality regulations, announced in a blog post days after the
midterms, helped repair his standing with both tech-savvy millennials and Silicon Valley donors. And the confirmation of Surgeon General Vivek Murthy
— who faced fierce opposition from the right over his support for gun control — gave liberals a rare victory on that issue. The president’s immigration
plan has boosted his standing 10 points among Hispanics, according to an NBC / Wall Street Journal poll released Thursday. But
aides also
acknowledge that the president's achievements wouldn't be gaining notice if they were still battling
some of the crises that dominated headlines over the summer — including the Ebola crisis and the flood of
unaccompanied minors over the southern border. One official argued theeffective resolution of those situations helped enable the president's work on
other issues to gain resonance. White House officials are also optimistic after a generally successful second ObamaCare enrollment period, and
believe the confirmation of a dozen judicial nominees in the lame duck will pay additional dividends down the road. In his final two years in office,
Obama hopes to use dozens of new officials confirmed in the Senate’s final days to both protect his first-term accomplishments and build upon them.
Some executive action will also look to shore up the president’s standing on the issue of financial reform. “I do anticipate that we’re going to expend
some time and energy next year and the year after trying to counter the efforts of Wall Street firms and their lobbyists,” Earnest said earlier this week.
And the White House is thought to be preparing additional action to help blue-collar workers, including a new regulation forcing employers to make
more workers eligible for overtime pay. Earnest and other White House officials have also acknowledged that they’re preparing for the president to
much more aggressively use his veto pen in the coming months. Republicans have indicated they plan to pass legislation on a slew of hot-button
issues, from the Keystone XL pipeline to ObamaCare to repealing Obama’s immigration reform actions. Each instance
is certain to offer red
the president and congressional Democrats the opportunity to stand unified
against the rollback of their policy priorities. “The veto will be an opportunity to redefine himself against the Congress,” said
meat to Republicans, but also give
Southern Methodist University political scientist Cal Jillson. “A number of bills that Republicans might send him on fiscal and economic issues generally
he can characterize as the same old Republican nonsense that brought us the crisis.”
Keystone guts U.S. climate cred—extinction
350, leading global warming advocacy group—board members include Bill McKibben and a large number of prominent climate
scientists, “Rejecting Keystone XL Crucial to U.S. Credibility in Global Climate Talks,” 350, 12—11—14, http://350.org/pressrelease/rejecting-keystone-xl-crucial-to-u-s-credibility-in-global-climate-talks/
As delegates from nearly 200 countries and indigenous tribal nations gather in Lima this week to develop a framework for a historic
international deal to combat catastrophic climate change, President Obama and Secretary Kerry have an opportunity to
cement the role of the U nited S tates as a global leader on climate issues. The key step? Rejecting the
Keystone XL tar sands pipeline. “We have seen positive steps taken by the U.S. in recent weeks, and that
should be applauded,” said Nauru Ambassador Marlene Moses, who chairs the Association of Small Island States. “Now is
not the time to call the superpower’s commitment to tackling this crisis into question by letting
this dirty, myopic, and irresponsible project go forward.” Activists will be pressuring Secretary Kerry on the pipeline as he
arrives in Lima on Thursday. At 11:00am Lima time this Thursday, climate groups are hosting a #NoKXL “twitter storm” to flood the
#COP20 hashtag with tweets urging rejection. At 3:30pm, activists will host a demonstration against the tar sands inside the COP20
conference center. John Kerry Big cop20 nokxl-01 “Citizens around the world are calling out for leadership in the global effort to fight
climate change as we move towards Paris, and the recent actions taken by the Obama administration suggest they may be
listening. Approving the Keystone XL pipeline would swing a huge hammer to the delicate credibility the
U.S. has built in recent months,” said David Turnbull, Campaigns Director of Oil Change International. “Keystone XL is a
climate disaster and completely inconsistent with the U.S. commitments being put forward at these talks,” said 350.org
Communications Director Jamie Henn, who is at the talks in Lima. “The U.S. can join the world in pushing for progress or be
sidelined as a climate laggard like Canada and Australia. Approving Keystone XL would undermine U.S. credibility in this process.”
“The Obama Administration has made incredible progress of late; but approving the Keystone XL tar sands
pipeline cuts against the President’s commitment to fight climate change and ability to bring the rest of the world
along to safeguard our future,” said Jake Schmidt, International Program Director, Natural Resources Defense Council. The
controversial proposed pipeline project would be a disaster for the climate by supporting the massive expansion of Canada’s dirty
tar sands, which the Canadian government has made clear they have no plans to regulate.
It has become a test of the
Obama Administration’s commitment to fighting climate change, both at home and abroad. Former EU
Commissioner for Climate Action Connie Hedegaardhas said that rejecting Keystone “would be an extremely strong signal for the
Obama administration.” Many credit the success of this round of climate talks compared to past summits to the
willingness the U nited S tates has shown to make meaningful progress on climate, through the Obama
Administration’s proposed power plant regulations and the climate accord recently reached between the U.S. and China. When
world leaders gather again next year in Paris to finalize a global climate deal, having rejected Keystone
XL would send a strong signal that the U nited S tates is prepared to take initiative to keep fossil fuels in the
ground to avert climate disaster–and it would be a model for other world leaders to similarly steer their
countries away from dirty fuels toward cleaner ones. Approving the pipeline or allowing the process to continue
to drag on would undermine the Obama Administration’s credibility going into these crucial talks, and
could threaten to negate the important progress being made on the global stage to leave a livable
planet for future generations.
OFF
Patient-doctor trust is high
Giroux, 14 -- Bloomberg reporter
[Greg, "Doctors Running for Congress Ditch Suits for White Coats," Bloomberg, 7-13-14, www.bloomberg.com/news/2014-0714/doctors-running-for-congress-ditch-suits-for-white-coats.html, accessed 8-24-14]
On the 2014 campaign trail, white is the new olive drab. After the 2001 terrorist attacks on the U.S., political candidates
with military ties showed up in their ads in uniform. This year, those with medical backgrounds are attacking Obamacare wearing
their white coats. It’s no accident: polls show nurses and doctors are among the most trusted people in
America. Politicians are among the least trusted. All three commercials for Monica Wehby, an Oregon Republican seeking to
unseat Democratic Senator Jeff Merkley, have shown her in a hospital setting. “As a pediatric neurosurgeon, I know firsthand how
devastating Obamacare is for Oregon families and patients,” Wehby said in one of her ads, which was interspersed with footage of
the candidate in surgical scrubs. The “Grey’s Anatomy” backdrop comes as Republicans seek to gain control of the U.S. Senate
and, with their House majority counterparts, pass a law repealing 2010’s Affordable Care Act. The quest is gaining urgency as
Americans become more accepting of the law. Republicans need a net gain of six seats for a Senate majority. Fifty-three percent of
Americans oppose the law, though just 32 percent say it should be repealed, according to a Bloomberg National Poll last month.
Fifty-six percent say they want to keep Obamacare with “small modifications.” Wardrobe Messaging The latest wardrobe
preferences for political ads also put distance between some candidates and the unpopular Congress they are seeking to join.
About 82 percent of Americans say nurses have a “high or very high level” of honesty and ethical
standards, the top spot among 22 professions rated in a December Gallup survey. Pharmacists were tied for second at
70 percent, and medical doctors were tied with military veterans for fourth at 69 percent. Medical
professionals have high approval ratings because people view them as “primary care-givers,” said
Frank Newport, Gallup’s editor-in-chief.
Organ sales collapse doctor-patient trust
Caplan, 14 – NYU bioethics division head and professor
[Arthur, Ph.D. in the history and philosophy of science from Columbia, Drs. William F and Virginia Connolly Mitty Professor and head
of the Division of Bioethics at New York University Langone Medical Center in New York City, "Reply to Cherry," Contemporary
Debates in Bioethics, google books, 70-71, accessed 8-18-14]
Medicine is a business, but it is also a profession: one that relies on trust. If commercial concerns are
seen as overwhelming the protection of patient interests, then medicine will no longer be able to
function. If doctors do useless tests on patients solely¶ to make money, then patients come to distrust recommendations for
tests. If doctors will remove your kidney, cornea, lobe of liver, or limbs solely so that you and they may turn a
buck, patients soon will come to completely distrust their doctors . Transplantation depends upon
trust-to obtain organs such as hearts¶ and lungs, people must believe their loved ones are truly dead
before removal. Trust in that the surgeon will not give you an inferior or infected organ just to get a
paycheck. Trust in that you cannot bribe your way to access to an organ ahead of those in greater¶ need.
There is nothing that will destroy trust more in transplant than showing that doctors are quite
willing to harm their patients-especially those who are poor or vulnerable solely and only for
money.
Key to solve bioterror- research, response and treatment
Jacobs, 5 – MD; Boston University professor of medicine
[Alice, director of Cardiac Catheterization Laboratory and Interventional Cardiology, "Rebuilding an Enduring Trust in Medicine,"
Circulation, 2005, circ.ahajournals.org/content/111/25/3494.full#xref-ref-3-1, accessed 8-18-14]
To be sure, we will learn about the emerging science and clinical practice of cardiovascular disease over the next four days. But
there is an internal disease of the heart that confronts us as scientists, as physicians, and as healthcare
professionals. It is a threat to us all—insidious and pervasive—and one that we unknowingly may spread. This threat is
one of the most critical issues facing our profession today. How we address this problem will shape the future of
medical care.¶ This issue is the erosion of trust.¶ Lack of trust is a barrier between our intellectual
renewal and our ability to deliver this new knowledge to our research labs, to our offices, to the bedside of
our patients, and to the public. Trust is a vital, unseen, and essential element in diagnosis, treatment, and
healing. So it is fundamental that we understand what it is, why it’s important in medicine, its recent decline, and what we can all
do to rebuild trust in our profession. Trust is intrinsic to the relationship between citizens around the world and the institutions that
serve their needs: government, education, business, religion, and, most certainly, medicine. ¶ Albert Einstein recognized the
importance of trust when he said, “Every kind of peaceful cooperation among men is primarily based on mutual trust.”1 In our time,
trust has been broken, abused, misplaced, and violated. The media have been replete with commentaries, citing stories of
negligence, corruption, and betrayal by individuals and groups in the public and private sectors, from governments to corporations,
from educational institutions to the Olympic Organizing Committee. These all are front-page news. Perhaps the most extreme
example is terrorism, in which strangers use acts of violence to shatter trust and splinter society in an ongoing assault on our shared
reverence for human life.¶ Unfortunately, we are not immune in our own sphere of cardiovascular medicine. The physicianinvestigator conflicts of interest concerning enrollment of patients in clinical trials, the focus on medical and nursing errors, the highprofile medical malpractice cases, the mandate to control the cost of health care in ways that may not be aligned with the best
interest of the patient—all of these undermine trust in our profession. At this time, when more and more public and private
institutions have fallen in public esteem, restoring trust in the healthcare professions will require that we understand the importance
of trust and the implications of its absence.¶ Trust is intuitive confidence and a sense of comfort that comes from the belief that we
can rely on an individual or organization to perform competently, responsibly, and in a manner considerate of our interests.2 It is
dynamic, it is fragile, and it is vulnerable. Trust can be damaged, but it can be repaired and restored. It is praised where it is evident
and acknowledged in every profession. Yet it is very difficult to define and quantify. ¶ Trust is easier to understand than to measure.
For us, trust may be particularly difficult to embrace because it is not a science. Few instruments have been designed to allow us to
evaluate it with any scientific rigor. Yet, trust is inherent to our profession, precisely because patients turn to us
in their most vulnerable moments, for knowledge about their health and disease. We know trust when
we experience it: when we advise patients in need of highly technical procedures that are associated with
increased risk or when we return from being away to learn that our patient who became ill waited for us to make a decision and
to discuss their concerns, despite being surrounded by competent colleagues acting on our behalf. ¶ Many thought leaders in
the medical field understand the importance of trust.3 When asked whether the public health
system could be overrun by public panic over SARS and bioterrorism, C enters for D isease C ontrol and
Prevention Director Julie Gerberding replied, “You can manage people if they trust you. We’ve put a
great deal of effort into improving state and local communications and scaled up our own public affairs capacity…we’re
building credibility, competence and trust.”4¶ Former H ealth and H uman S ervices Secretary Donna Shalala
also recognized the importance of trust when she said, “If we are to keep testing new med icine s and
new approaches to curing disease, we cannot compromise the trust and willingness of patients to
participate in clinical trials.”5¶ These seemingly intuitive concepts of the importance of trust in 21st century medicine
actually have little foundation in our medical heritage. In fact, a review of the early history of medicine is astonishingly devoid of
medical ethics. Even the Codes and Principles of Ethics of the American Medical Association, founded in 1847, required patients to
place total trust in their physician’s judgment, to obey promptly, and to “entertain a just and enduring sense of value of the services
rendered.”6 Such a bold assertion of the authority of the physician and the gratitude of the patient seems unimaginable today.¶ It
was not until the early 1920s that role models such as Boston’s Richard Cabot linked patient-centered medical ethics with the best
that scientific medicine had to offer,6 and Frances Weld Peabody, the first Director of the Thorndike Memorial Laboratory at the
Boston City Hospital, crystallized the ethical obligation of the physician to his patient in his essay “The Care of the Patient.”7 In one
particularly insightful passage, Peabody captures the essence of the two elements of the physician’s ethical obligation: He must
know his professional business and he must trouble to know the patient well enough to draw conclusions, jointly with the patient, as
to what actions are indeed in the patient’s best interest. He states: “The treatment of a disease may be entirely impersonal: The
care of the patient must be completely personal. The significance of the intimate personal relationship
between physician and patient cannot be too strongly emphasized, for in an extraordinarily large
number of cases both diagnosis and treatment are directly dependent on it.” Truly, as Peabody said, “The
secret to the care of the patient…is in caring for the patient.”7¶ This concept that links the quality of the physicianpatient relationship to health outcomes has indeed stood the test of time. Trust has been shown to
be important in its own right. It is essential to patients, in their willingness to seek care, their willingness
to reveal sensitive information, their willingness to submit to treatment, and their willingness to
follow recommendations. They must be willing for us to be able.
Continual research solves and deters bioterror
Chyba 4 - Co-Director of the Center for International Security and Cooperation (CISAC), Stanford Institute for International
Studies, and an Associate Professor at Stanford University
[Christopher & Alex Greninger, “Biotechnology and Bioterrorism: An Unprecedented World” Survival, 46:2, Summer 2004, http://iisdb.stanford.edu/pubs/20722/Chyba_2004.pdf]
In the absence of a comprehensive and effective system of global review of potential high-consequence research, we are
instead trapped in a kind of offence–defence arms race. Even as legitimate biomedical researchers develop
defences against biological pathogens, bad actors could in turn engineer countermeasures in a kind of directed
version of the way natural pathogens evolve resistance to anti-microbial drugs. The mousepox case provides a harbinger of
what is to come: just as the United States was stockpiling 300m doses of smallpox vaccine as a defence against a terrorist
smallpox attack, experimental modification of the mousepox virus showed how the vaccine could possibly be circumvented.
The United States is now funding research on antiviral drugs and other ways of combating smallpox that might be effective
against the engineered organism. Yet there are indications that smallpox can be made resistant to one of the few known
antiviral drugs. The future has the appearance of an eternal arms race of measures and countermeasures.
The ‘arms race’ metaphor should be used with caution; it too is in danger of calling up misleading analogies to the nuclear
arms race of the Cold War. First, the biological arms race is an offence–defence race , rather than a
competition between offensive means. Under the BWC, only defensive research is legitimate. But more fundamentally, the
driver of de facto offensive capabilities in this arms race is not primarily a particular adversary, but rather the ongoing global
advance of microbiological and biomedical research. Defensive measures are in a race with nefarious
applicationsof basic research, much of which is itself undertaken for protection against natural disease. In a sense, we
are in an arms race with ourselves. It is hard to see how this arms race is stable – an offence granted comparable resources
would seem to be necessarily favoured. As with ballistic missile defence, particular defensive measures may be defeated by
offensive countermeasures. In
the biological case, implementing defensive measures will require not
only research but drug development and distribution plans. Offensive measures need not exercise this care, although
fortunately they will likely face comparative resource constraints (especially if not associated with a state programme), and
may find that some approaches (for example, to confer antibiotic resistance) have the simultaneous effect of inadvertently
reducing a pathogen’s virulence. The defence must always guard against committing the fallacy of the last move, whereas the
offence may embrace the view of the Irish Republican Army after it failed to assassinate the British cabinet in the 1984
Brighton bombing: ‘Today we were unlucky, but remember we have only to be lucky once – you will have to be lucky
always’.40 At the very least, the defence will have to be vigilant and collectively smarter than the offence. The
only way for the defence to win convincingly in the biological arms race would seem to be to succeed in
discovering and implementing certain de facto last-move defences, at least on an organism-by-organism
basis. Perhaps there are defences, or a web of defences, that will prove too difficult for any plausible non-state actor to
engineer around. Whether such defences exist is unclear at this time, but their exploration should be a long-term
research goal of US biodefence efforts. Progress might also have an important impact on international public
health. One of the ‘Grand Challenges’ identified by the Bill and Melinda Gates Foundation in its $200m initiative to improve
global health calls for the discovery of drugs that minimise the emergence of drug resistance – a kind of ‘last move’ defence
against the evolutionary countermeasures of natural microbes.41 Should a collection of such defensive moves
prove possible, bioterrorism might ultimately succumb to a kind of globalised dissuasion by denial :42
non-state groups would calculate that they could not hope to achieve dramatic results through
biological programmes and would choose to direct their efforts elsewhere.
Extinction- engineered pathogens
Sandberg, 8 -- Oxford University Future of Humanity Institute research fellow
[Anders, PhD in computation neuroscience, and Milan Cirkovic, senior research associate at the Astronomical Observatory of
Belgrade, "How can we reduce the risk of human extinction?" Bulletin of the Atomic Scientists, 9-9-2008, thebulletin.org/how-canwe-reduce-risk-human-extinction, accessed 8-13-14]
The risks from anthropogenic hazards appear at present larger than those from natural ones. Although great progress has been
made in reducing the number of nuclear weapons in the world, humanity is still threatened by the possibility of a global
thermonuclear war and a resulting nuclear winter. We may face even greater risks from emerging technologies. Advances in
synthetic biology might make it possible to engineer pathogens capable of extinction-level
pandemics. The knowledge, equipment, and materials needed to engineer pathogens are more
accessible than those needed to build nuclear weapons. And unlike other weapons, pathogens are
self-replicating, allowing a small arsenal to become exponentially destructive. Pathogens have
been implicated in the extinctions of many wild species. Although most pandemics "fade out" by
reducing the density of susceptible populations, pathogens with wide host ranges in multiple
species can reach even isolated individuals. The intentional or unintentional release of engineered
pathogens with high transmissibility, latency, and lethality might be capable of causing human
extinction. While such an event seems unlikely today, the likelihood may increase as biotechnologies continue to improve at a
rate rivaling Moore's Law.
case
Shortage: 1NC [8]
ONE—Can’t solve—market elasticity
Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern
California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES
TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25)
In resolving the policy implications of the conflict among ethical values, proponents of organ sales argue that the burden of
persuasion falls on those who urge prohibitions or restrictions because markets would make more organs available and hence save
more lives.150 The first response to such a claim is that a society that fails to develop and utilize all forms of medical interventions
to extend every life does not fail its citizens, whereas one that builds life-saving efforts on practices that are destructive of other
important values—of equality, dignity, and liberty—does.151 The second response—which does not depend upon taking a stance
on what constitutes a good society—is that good reasons exist to doubt proponents’ claims that a market run
according to acceptable ethical standards would, in the long run, produce a larger number of organs than can be achieved without
financial inducements, much less put an end to the shortage in organs.152
(footnote 152)
152. The notion that the “gap” between supply and demand can ever be closed ignores the
elasticity of demand. The large increase in the United States over the past twenty years in the number of
people waiting for a kidney transplant reflects not only the growing incidence of kidney disease (as
to which preventive efforts would be the preferable response) but
also the substantial increase in the number of
kidneys available for transplantation, which makes nephrologists more willing to place patients
on the waiting list. Were kidneys no longer scarce, physicians would list not only those patients
with less severe kidney failure but also those patients whose prospects for a good outcome are
lower because of comorbidities.
TWO—Crowd-out is more likely, comparative evidence
Capron, 14 – this evidence is responding directly to Beard who is cited in the footnotes - University Professor and Scott
H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN
DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE
AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25)
Free-market economists are quick to pronounce that the organ transplantation policies based on
the noncommercial model followed by most countries over the past three decades “have failed.” 153 This seems a
rather blinkered assessment of a system that has extended and improved millions of lives while also
providing a dramatic affirmation of human generosity and solidarity. There is no question that more organs are needed, but were
all countries to adopt the “best practices” used by the organ-procurement programs with the
highest rates of donation, a huge increase in transplantation would be possible without resort to
paying for organs . Indeed, during the first decade of this century, a concerted effort by the Department of Health and Human
Services led to an increase of more than twenty-five percent in the rate of donation in the United States.154 Moreover, if only a
small fraction of the amount that would need to be spent to purchase organs in a “regulated
market” were instead used to improve the present system, further substantial increases in the rate
of donation would be possible. But what of the claim that it is self-evident that paying for organs would
increase the net rate of donation?155 The extensive literature on “crowding out” suggests that
many people who are willing to donate in a voluntary, unpaid system would cease doing so once
paid donation became an accepted practice.156 It is not simply that one does not want to be played for a fool (by giving
away what others are paid for), but that the nature of the act changes when it is not experienced by the
donor, and seen immediately and universally by others, as something that is generous and ennobling. This
change would be especially pronounced if, as is likely to be the case, most organ vendors were
understood to be acting out of financial desperation. Although today’s most highly motivated donors—those who
are giving a kidney to a close relative—might be expected to be immune to such a change, this has been found not to be the case.
[R]ecently, when the U.S. rules for allocating deceased donor kidneys were changed to give
children on the waiting list greater access to deceased adult donors’ kidneys, parental donations
fell by a larger amount, so that overall fewer pediatric kidney transplants are being done while some
potential adult recipients have been deprived of a kidney that went to a child instead.157 Likewise, the
ready availability of
vended kidneys and liver lobes would leave most potential recipients disinclined to ask a relative
or friend to donate. Who would want to ask for such a gift from a loved one when his or her need for an organ can be met
without imposing any burden on that person and without enmeshing oneself in all the psychological and moral complexities that
arise in “the gift relationship”?158 Summarizing observational and experimental research over many decades by economists and
social psychologists, Sheila and David Rothman conclude that “although the case for the ‘hidden costs of rewards’ is certainly not
indisputable, it does suggest that a market in organs might reduce altruistic donation and overall supply.”159
(Footnote 153)
153. T. RANDOLPH BEARD , DAVID L. KASERMAN & RIGMAR OSTERKAMP, THE GLOBAL ORGAN SHORTAGE:
ECONOMIC CAUSES, HUMAN CONSEQUENCES, POLICY RESPONSES 1 (2013).
THREE—status quo solves
A. Xenotransplantation- new discoveries
Moline, 14 – Truth Atlas editor
[Aaron, "Xenotransplantation Could Solve Organ Crisis," 5-23-14, truthatlas.com/xenotransplantation-could-solve-organ-crisis/,
accessed 8-28-14]
Xenotransplantation Could Solve Organ Crisis
Scientists are trying to resurrect a project, decades in development, that could potentially alleviate the dire shortage of implantable
organs in humans. It’s called xenotransplantation, and it means altering the organs of other animals into
becoming functional in a human body, providing an endlessly renewable source of hearts and other
organs to those critically ill and still waiting for a viable donor. It isn’t exactly a new idea to use animal organs to replace damaged
human ones. After all, we share a common internal design with many different animals, and some are nearly identical to our own.
Recently, the discovery that human and pig skin are very similar has led to the use of animal-based skin grafts that have saved the
lives of burn victims worldwide. However, our powerful immune systems, which are poised to attack any foreign object from any
source, including human donors, remain an obstacle to using internal organs from these same animals for xenotransplantation.
Now, a new project has demonstrated that such an operation is indeed possible by successfully
implanting a pig heart within the body of a baboon. While this may sound like mad science, it is the first step in
developing a method to give these organs to the people who need them most. Of course, this achievement could not have been
accomplished without a substantial effort from scientists at the US National Heart, Lung and Blood Institute in Bethesda, Maryland.
They first observed the method by which the primate body rejected the new organ. Two different sets of protections exists within our
bodies and those of the baboons to keep foreign organs out. The first is a system of detection, which the scientists fooled by
masking the organ, modifying its genome not to produce the molecule that signals the immune system. The second is the weaponry
with which the immune system attacks these invaders, which had to be shielded against with the genetic introduction of a new
protein that bolsters the organ’s defenses. The next step was to correct the problems that arose over time when an animal lived with
a mismatched heart. They noticed a tendency for blood clots to form in both donated hearts and kidneys, both of which pose serious
risks to the animal. A third genetic modification was needed: the addition of a human anti-clotting substance called thrombomodulin
to keep the organ healthy over time. The
results have been an astounding increase in the efficacy of
xenotransplantation . Hearts that once gave out after 6 months now last 2 years, providing the foundation of the
technology that one day could provide the organs patients desperately need. As the global population ages, the
demand for these organs will only rise as the supply ebbs. When that day arrives, we may need to rely on our porcine friends to give
us a heart.
B. 3D printing- new tech is a quantum leap forward
Gilpin, 14 -- TechRepublic staff writer, citing Dr. Jay Hoying, the Division Chief of Cardiovascular Therapeutics at the
Cardiovascular Innovation Institute at Louisville
[Lyndsey, "New 3D bioprinter to reproduce human organs, change the face of healthcare," Tech Republic, 8-1-14,
www.techrepublic.com/article/new-3d-bioprinter-to-reproduce-human-organs/, accessed 8-28-14]
New 3D bioprinter to reproduce human organs, change the face of healthcare
Researchers are only steps away from bioprinting tissues and organs to solve a myriad of injuries and illnesses.
TechRepublic has the inside story of the new product accelerating the process. If you want to understand how close
the medical community is to a quantum leap forward in 3D bioprinting, then you need to look at the
work that one intern is doing this summer at the University of Louisville. A team of doctors, researchers, technicians, and
students at the Cardiovascular Innovation Institute (CII) on Muhammad Ali Boulevard in Louisville, Kentucky swarm around the
BioAssembly Tool (BAT), a square black machine that's solid on the bottom and encased in glass on three sides on the top. There's
a large stuffed animal bat sitting on the machine and a computer monitor on the side, showing magnified images of the biomaterial
that the machine is printing. This team stands at the forefront of research in 3D bioprinting, as they methodically take steps toward
printing a working human heart. As part of this work, the team is also pioneering breakthroughs in printing
human stem cells -- a move that could remove the raging ethical dilemmas associated with stem
cells and potentially take regenerative medicine to new heights. The combination of these stem cells and 3D bioprinting is
going to help repair or replace damaged human organs and tissues, improve surgeries, and ultimately give patients far better outcomes in dealing with a wide range of illnesses
and injuries. But, there are problems with BAT -- as advanced as it is from its surprising background as a military project. It's way too slow and printing anything with it is a
tortuously manual process. The printhead runs on a three-axis robot that doesn't handle curves very well. No one at the lab knows the limitations and challenges of BAT better
than a summer intern named Katie, an undergrad from Georgetown University. She's in Louisville as part of a summer program for the Howard Hughes Medical Institute that
exposes students to cutting edge research and lets them participate in groundbreaking work. Katie's not sure what she wants to do when she finishes her bachelor's degree in
mathematics but she has thrown herself into her work at the CII with full intensity this summer. A big part of what Katie does is build intricate scripts to tell BAT what to print. It's
similar to a computer programmer writing in assembly language to give a computer system an exact set of instructions. It's an incredibly laborious process and it involves Katie
going back and forth with Dr. Jay Hoying, the Division Chief of Cardiovascular Therapeutics at CII and one of the leaders of the 3D bioprinting project. "What's interesting is
Hoying and his team are
about to get a new 3D bioprinting solution that will accelerate their work so significantly that what has
Katie's background in mathematics," said Hoying, "which is really essential here because it's basically a geometry problem." But
taken Katie half the summer will soon take half a day, according to Hoying. This new solution's hardware, BioAssemblyBot (BAB),
runs as a six-axis robot that is far more precise than BAT. The real difference, however, is in the software: Tissue Structure
Information Modeling (TSIM), which is basically a CAD program for biology. It takes the manual coding out of the process and
replaces it with something that resembles desktop image editing software. It allows the medical researchers to scan and manipulate
3D models of organs and tissues and then use those to make decisions in diagnosing patients. And then, use those same scans to
model tissues (and eventually organs) to print using the BAB. "It's a big step forward in the capability and
technology of bioprinting," said Hoying, "but what someone like me is really excited about is now it enables me to do so much more." Hoying went back to
the example of his highly-capable intern, Katie. "Katie has spent half the summer just understanding and scripting up and doing this," he said. "Now if Katie can do that in half a
day, I can do more biology, I can do more experiments. I can explore new cell combinations.... In that same half a summer I could have explored different structures, different
cell-[to]-cell combinations, experiment here growing them up, etc. Where she's taking half the summer to understand the geometry, script it out, test it... with the BAB and the
TSIM, I would have finished a handful of experiments." Bioprinting's new robot BAB and TSIM are an integrated package built by Advanced Solutions, a private biotech
company located in suburban Louisville. The new solution officially launches today -- Friday, August 1, 2014 -- and Hoying's CII is not the only lab ready to jump on it. In fact,
Hoying is concerned that demand could be so strong that it could interfere with his facility getting one as soon as he would hope, although that seems unlikely considering
Hoying was an important collaborator and consultant for Advanced Solutions in creating the product. While the lab where Katie and Dr. Hoying run their experiments is
downtown next to the hospitals and cutting edge medical facilities, the Advanced Solutions office is about 20 miles east, tucked away in a suburban office park that's also home
to a tree care service, a construction company, a dental association, a US Postal Service branch, and a handful of small healthcare companies. The building that houses
Advanced Solutions sits just down a hill off Nelson Miller Parkway, and less than 1000 feet from the I-265 interstate highway. From the outside, there's little indication that the
single story brick structure houses a team of 65 people who are working on a hardware and software solution that could revolutionize modern medicine. Advanced Solutions has
been around since 1987. During most of the time since then, it has been a software provider building solutions on top of Autodesk for specific industries. But, in October 2010,
Advanced Solutions CEO Michael Golway took an alumni tour of the CII -- since Golway is a University of Louisville alum and the university is a key partner of the facility.
Golway told TechRepublic, "At the end of the presentation, Dr. Stu Williams passionately summarized the CII business model and I was not only impressed by the CII
innovation, team of researchers and focus on cardiovascular solutions but intrigued by the possibilities that Advanced Solutions engineering know-how could contribute in a
positive and profound way to helping his team. I followed back up with Dr. Williams one-on-one and we became fast friends." That began the journey that would lead to the
integrated solution that Golway and his team devised to meet the needs of Williams, Hoying, and researchers and hospitals throughout the world. "Over the course of 2.5 years
we would periodically meet and I learned about some of the technological workflow challenges that slowed his team from advancing the biology research to achieve the Total
Bioficial Heart," Golway said. "Dr. Williams and eventually Dr. Hoying also invested time in learning more about the Advanced Solutions team and our capabilities. After 2.5
years of building a terrific working relationship, listening, learning and collaborating I brought forward an engineering design concept for Dr. Williams and Dr. Hoying to consider
that was intended to solve the tissue design technology problem." Hoying and Williams, who is the division chief of the bioficial heart program at the CII, are both widely
respected cell biologists who came to Louisville from Arizona to work together. They were obviously impressed that Golway's solution could get them closer to their goal of
creating that "Total Bioficial Heart." Golway continued, "In March 2013, Advanced Solutions Life Sciences, LLC was formed as a wholly owned subsidiary of Advanced
Solutions, Inc. to engineer, fabricate and commercialize the technology in support of that initial concept design. Today the BioAssemblyBot and [the] TSIM software integrated
this work as part of a larger trend of digitizing
the medical and biological space, which is destined to unleash other new advances as well. "What's been really
interesting to me is that we're on a trajectory here where we're really treating biology as more of an information technology," Golway
said. "That's incredibly exciting to us because IT grows exponentially -- instead of just the hardcore traditional discovery that biology
has been tracking on, if we can translate that into IT we can take that experimentation and rapidly start looking at optimization. How
to combine cell types in a way to create cell types and structures. The exponential curve is already there but this
technology allows you to take the next step."
solution are the work product from that endeavor." Beyond the launch of his company's product, Golway views
C. Organ cloning- tech exists now
Aronson, 13 -- Organ Transplant Initiative founder
[Bob, "Artificial and Bioengineered Organs Can End the Shortage," 2-10-13, https://bobsnewheart.wordpress.com/category/endingthe-organ-shortage-solutions/, accessed 8-28-14]
In June 2011, an Eritrean man entered an operating theater with a cancer-ridden windpipe, People had received
windpipe transplants before, but this one was different. His was the first organ of its kind to be completely grown
in a lab using the patient’s own cells. The windpipe is one of the latest successes in the ongoing
quest to grow artificial organs in a lab. The goal is deceptively simple: build bespoke organs for individual patients by
sculpting them from living flesh on demand. No-one will have to wait on lengthy transplant lists for donor
organs and no-one will have to take powerful and debilitating drugs to prevent their immune systems
from rejecting new body parts. Scaffolds for Tissue Repair energy pulsar Researchers are making use of advances in knowledge of stem cells, basic
cells that can be transformed into types that are specific to tissues like liver or lung. They are learning more about what they call scaffolds, compounds that act like mortar to
hold cells in their proper place and that also play a major role in how cells are recruited for tissue repair. Tissue engineers caution that the work they are doing is experimental
and costly, and that the creation of complex organs is still a long way off. But they are increasingly optimistic about the possibilities. Bioartificial Liver Boston company HepaLife
is working on a “bioartificial” liver using a proprietary line of liver stem cells. Once the patient’s blood is separated into plasma and blood cells, a external bioreactor unit with
those stem cells inside can reduce levels of toxic ammonia by 75% in less than a day. Bioartificial Hand Smarenergy coming from a handtHand is a bioadaptive hand that can
actually feel. Its 40 sensors communicate back and forth directly with the brain using nerve endings in the arm. The hand sends its sensory input to the brain, and the brain
sends instructions for movement to the hand. The result? It can pick up a plastic water bottle without crushing it, or pour a drink without spills. BioLung MC3 BioLung is a sodacan-shaped implantable device that uses the heart’s pumping power to move blood through its filters. It’s designed to work alongside a natural lung, exchanging oxygen from
the air with carbon dioxide from the bloodstream. So far, it’s been tried on sheep, where six of the eight animals on the BioLung machine survived for five days. Human trials are
expected within the next couple of years. 3D Organ Printing Organ printing, or the process of engineering tissue via 3D printing, possesses revolutionary potential for organ
transplants. The creation process of artificial tissue is a complex and expensive process. In order to build 3D structures such as a kidney or lung, a printer is used to assemble
cells into whichever shape is wanted. For this to happen, the printer creates a sheet of bio-paper which is cell-friendly. Afterwards, it prints out the living cell clusters onto the
paper. After the clusters are placed close to one another, the cells naturally self-organize and morph into more complex tissue structures. The whole process is then repeated to
Using the
patient’s own cells as a catalyst, artificial organs may soon become mainstream practice among
treatment centers worldwide. As the health of the nation delves down to record negatives, organ printing may be the
establishment’s answer to a number of preventable conditions. The above alternatives to human organs are but
the tip of the iceberg. Medical science and technology are on the verge of incredible
breakhroughs that will extend life and, at some point, end the need for human organ donation, anti-rejection
add multiple layers with each layer separated by a thin piece of bio-paper. Eventually, the bio-paper dissolves and all of the layers become one.
drugs and maybe even invasive surgery.
FOUR—no one will sell
Caplan 8 – Arthur, PhD, a Hastings Center Fellow, chairs the department of medical ethics at the University of
Pennsylvania“Organ Transplantation” in From Birth to Death and Bench to Clinic: The Hastings Center Bioethics Briefing Book for
Journalists, Policymakers, and Campaigns, ed. Mary Crowley (Garrison, NY: The Hastings Center, 2008), 129-132.
It is hard to imagine many people in wealthy countries eager to sell their organs upon their death .
if compensation is relatively high, few will agree to sell . That has been the experience
with markets in human eggs for research purposes and with paid surrogacy in the U nited S tates— prices
have escalated, but there are still relatively few sellers . Selling organs, even in a tightly regulated market,
In fact, even
violates the ethics of medicine. The core ethical norm of the medical profession is the principle, “Do no harm.” The only way that
removing an organ from someone seems morally defensible is if the donor chooses to undergo the harm of surgery solely to help
another, and if there is sufficient medical benefit to the recipient.
FIVE—shortage exaggerated, donations increasing
Segev, 10 -- Johns Hopkins professor of surgery
[Dorry, MD, PhD, and S.E. Gentry, Department of Epidemiology, Johns Hopkins School of Public Health, Department of
Mathematics, United States Naval Academy, "Terminology Influences Many Aspects of the Market/Incentives Debate," American
Journal of Transplantation, 2010, 10, 2375, ebsco, accessed 8-27-14]
Carefully examining the
kidney waiting list reveals that the 'tremendous organ shortage' is widely distorted , with totals on the
waiting list inflated by inactive candidates who are not eligible for a transplant (approximately one-third of
the list). For exam- ple, between 2002 and 2007, McCullough and colleagues showed that the active kidney waiting list grew by
In seeking more precise terminology, we wish to clarify two other terms critical to this debate.
only 10%, indicating a near steady-state of new eligible regis- trants and transplants for them, while the inactive kidney waiting list
grew by 282% (2). Furthermore, live donation rates are often said to have 'stalled' since 2004. However, living
donation rates tripled in the preceding 15 years (3). The level donation rates since 2004 suggest
sustainability of these historic highs in donation. Some areas of living donation have seen
exponential growth in the last few years. Nondirected donation grew from 2 in 1998 to 56 in 2002 to 137 in 2009 (4,5).
Paired donation grew from 3 in 2000 to 39 in 2004 to 419 in 2009 (5,6). These donors do not comprise a large proportion of the
living donor pool at this early stage and so do not con- tribute to a visible overall rise in kidney donation. As they continue to
increase, however, these sources of donors will likely play a more obvious role in the future. In fact, the rise in living donation
between 2008 and 2009 is partly attributable to these novel modalities.
SIX—Doctors won’t do it- collapses solvency
Segev, 10 -- Johns Hopkins professor of surgery
[Dorry, MD, PhD, and S.E. Gentry, Department of Epidemiology, Johns Hopkins School of Public Health, Department of
Mathematics, United States Naval Academy, "Kidneys for Sale: Whose Attitudes Matter?," American Journal of Transplantation,
2010, 10, 1113-1114, ebsco, accessed 8-27-14]
nothing else is relevant until physicians support organ sales. And , right now, they don't . In a
recent survey of the American Society of Transplant Surgeons, only 20% of transplant surgeons-those actually
doing the transplants-supported cash payments for deceased or live donation (2). Similar lack of support was found
among physicians from other societies as well (3). Clearly an organ market will not be much of a market with so
few willing to perform the transplants or refer the patients. And a rift in the transplant community
First,
resulting from a marginally sup- ported organ market will likely be much more detrimental to
organ transplantation in the United States than any pu- tative increase in donation from establishing
financial incentives (4). As such, those seeking to better understand the viability of organ markets
should focus first on the physicians.
Trafficking: 1NC [5]
ONE—status quo solves—international cooperation
Danovitch et al, 13 - David Geffen School of Medicine at UCLA, Los Angeles, CA (Gabriel, “Organ Trafficking and
Transplant Tourism: The Role of Global Professional Ethical Standards—The 2008 Declaration of Istanbul” Transplantation. 2013
Jun 15;95(11):1306-12. doi: 10.1097/TP.0b013e318295ee7d.
By 2005, human organ trafficking, commercialization, and transplant tourism had become a prominent and pervasive influence on
transplantation therapy. The most common source of organs was impoverished people in India, Pakistan, Egypt, and the
Philippines, deceased organ donors in Colombia, and executed prisoners in China. In response, in May 2008, The Transplantation
Society and the International Society of Nephrology developed the Declaration of Istanbul on Organ Trafficking and Transplant
Tourism consisting of a preamble, a set of principles, and a series of proposals. Promulgation of the Declaration of Istanbul and the
formation of the Declaration of Istanbul Custodian Group to promote and uphold its principles have demonstrated that concerted,
strategic, collaborative, and persistent actions by professionals can deliver tangible changes. Over the past 5 years, the
Declaration of Istanbul Custodian Group organized and encouraged cooperation among professional
bodies and relevant international, regional, and national governmental organizations, which has
produced significant progress in combating organ trafficking and transplant tourism around the
world. At a fifth anniversary meeting in Qatar in April 2013, the DICG took note of this progress and set forth in a Communiqué a
number of specific activities and resolved to further engage groups from many sectors in working toward the Declaration’s
objectives.
By the middle of the first decade of the 21st century, the sale of human organs for transplantation, first reported in the 1980s (1),
had metamorphosed from a hidden and limited activity in the back streets of a handful of developing countries to a widespread, and
sometimes brazen, activity that involved potential recipients traveling to clinics around the world to receive a kidney from poor, and
poorly paid, “donors.” Trafficking in organs and the persons from whom they were removed in India, Pakistan, Egypt, the
Philippines, and Eastern Europe—or executed prisoners in China—came to have a pervasive, malign influence on transplant
activities in many parts of the world (2). Growing numbers of transplant candidates with personal wealth or support from
governments or health insurers were flying from the Gulf states, Israel, Europe, and North America to Eastern Europe, Asia, South
Africa, and Latin America to obtain kidney transplants at for-profit hospitals and clinics they had found through brokers or online
advertisements.
The growing rate of kidney sales over the preceding 20 years was driven by the needs of wealthy or well-insured recipients. The
rationale for allowing the practice was provided by three groups: (a) philosophers who think that “donors” should be allowed to
exercise their autonomy by selling their organs; (b) believers in neoclassic economics, who think that treating organs as a market
commodity will increase the supply; and (c) nephrologists and surgeons whose eagerness to serve their patients’ needs have led
them to flirt with “regulated markets” in kidneys and other organs (3). None of these positions stand up in the face of evidence or
decades of experience have shown that the sellers of organs
everywhere are the poor or the vulnerable, whose actions reflect financial desperation and
ignorance, not autonomous agency. The central bioethical principles of beneficence and justice are equally abused by
organ sales, which crowd out altruistic donations, leave paid donors worse off, and exploit the poor
to benefit the rich (4). Second, the transplant rates in countries with voluntary, unpaid systems
exceed those in countries where organs are sold , and the number of available organs actually
increases when sales are combated because the act of donating ceases to be mercenary and becomes a human
professional ethical standards. As to the first,
gesture of solidarity and generosity. Third, it is wishful thinking to believe that creating a marketplace will provide more organs for
their patients. Reliance on payments—including financial incentives and comparable monetary “rewards” for donors, or for families
in the case of deceased donation—paints organ donation with the brush of financial vulnerability and sullies respect for human
dignity. Unfortunately, the willingness of people in the third category to embrace the first two arguments has lent credibility to
physicians and hospitals in developing countries that have profited financially from transplanting organs from the poor into wealthy
and well-insured patients. By promoting explicit or disguised organ commercialism, these latter actors exploit the arguments of
people in the third category who have called for “experimenting” with financially motivated organ donation (3), in an attempt to divert
international attention from the history of destitution, injuries, and even death among paid organ donors who have been left to live
with the legacy of exploitation.
TWO—no modeling- especially on markets. Their ev is epistemologically flawed
Moravcsik, 5 -- Princeton politics professor and European Union Program director
[Andrew, “Dream On America,” Newsweek 1/31/05, http://www.fsteiger.com/DreamOnAmerica.html, accessed 8-28-14]
Dream On America
The U.S. Model: For years, much of the world did aspire to the American way of life. But today countries
are finding more appealing systems in their own backyards. Not long ago, the American dream was a global
fantasy. Not only Americans saw themselves as a beacon unto nations. So did much of the rest of the world. East Europeans tuned
into Radio Free Europe. Chinese students erected a replica of the Statue of Liberty in Tiananmen Square. You had only to listen to
George W. Bush's Inaugural Address last week (invoking "freedom" and "liberty" 49 times) to appreciate just how deeply
Americans still believe in this founding myth. For many in the world, the president's rhetoric confirmed their worst fears of
an imperial America relentlessly pursuing its narrow national interests. But the greater danger may be a delusional America,
one that believes, despite
all evidence to the contrary , that the American Dream lives on, that America
remains a model for the world, one whose mission is to spread the word. The gulf between how Americans view
themselves and how the world views them was summed up in a poll last week by the BBC. Fully 71 percent of Americans see the
United States as a source of good in the world. More than half view Bush's election as positive for global security. Other studies
report that 70 percent have faith in their domestic institutions and nearly 80 percent believe "American ideas and customs" should
spread globally. Foreigners take an entirely different view: 58 percent in the BBC poll see Bush's re-election as a threat to world
peace. Among America's traditional allies, the figure is strikingly higher: 77 percent in Germany, 64 percent in Britain and 82 percent
in Turkey. Among the 1.3 billion members of the Islamic world, public support for the United States is measured in single digits. Only
Poland, the Philippines and India viewed Bush's second Inaugural positively. Tellingly, the anti-Bushism of the president's first term
is giving way to a more general anti-Americanism. A plurality of voters (the average is 70 percent) in each of the 21 countries
surveyed by the BBC oppose sending any troops to Iraq, including those in most of the countries that have done so. Only one third,
disproportionately in the poorest and most dictatorial countries, would like to see American values spread in their country. Says
Doug Miller of GlobeScan, which conducted the BBC report: "President Bush has further isolated America from the world. Unless
the administration changes its approach, it will continue to erode America's good name, and hence its ability to effectively influence
world affairs." Former Brazilian president Jose Sarney expressed the sentiments of the 78 percent of his countrymen who see
America as a threat: "Now that Bush has been re-elected, all I can say is, God bless the rest of the world." The truth is that
Americans are living in a dream world. Not only do others not share America's self-regard, they no longer
aspire to emulate the country's social and economic achievements. The loss of faith in the American
Dream goes beyond this swaggering administration and its war in Iraq. A President Kerry would have had to
confront a similar disaffection, for it grows from the success of something America holds dear: the spread of democracy, free
markets and international institutions; globalization, in a word. Countries today have dozens of political, economic
and social models to choose from. Anti-Americanism is especially virulent in Europe and Latin
America, where countries have established their own distinctive ways; none made in America .
Futurologist Jeremy Rifkin, in his recent book "The European Dream," hails an emerging European Union based on generous social
welfare, cultural diversity and respect for international law; a model that's caught on quickly across the former nations of Eastern
Europe and the Baltics. In Asia, the rise of autocratic capitalism in China or Singapore is as much a "model" for
development as America's scandal-ridden corporate culture. "First we emulate," one Chinese businessman recently told the board
of one U.S. multinational, "then we overtake." Many are tempted to write off the new anti-Americanism as a temporary perturbation,
or mere resentment. Blinded by its own myth , America has grown incapable of recognizing its flaws .
For there is much about the American Dream to fault. If the rest of the world has lost faith in the American model, political,
economic, diplomatic, it's partly for the very good reason that it doesn't work as well anymore. AMERICAN DEMOCRACY: Once
upon a time, the U.S. Constitution was a revolutionary document, full of epochal innovations: free elections, judicial review, checks
and balances, federalism and, perhaps most important, a Bill of Rights. In the 19th and 20th centuries, countries around the world
copied the document, not least in Latin America. So did Germany and Japan after World War II. Today? When nations write a new
constitution, as dozens have in the past two decades, they seldom look to the American model. When the soviets withdrew from
Central Europe, U.S. constitutional experts rushed in. They got a polite hearing, and were sent home. Jiri Pehe, adviser to former
president Vaclav Havel, recalls the Czechs' firm decision to adopt a European-style parliamentary system with strict limits on
campaigning. "For Europeans, money talks too much in American democracy. It's very prone to certain
kinds of corruption, or at least influence from powerful lobbies," he says. " Europeans
would not want to follow
that route ." They also sought to limit the dominance of television, unlike in American campaigns where, Pehe says, "TV
debates and photogenic looks govern election victories." So it is elsewhere. After American planes and bombs freed the
country, Kosovo opted for a European constitution. Drafting a post-apartheid constitution, South Africa rejected American-style
federalism in favor of a German model, which leaders deemed appropriate for the social-welfare state they hoped to construct. Now
fledgling African democracies look to South Africa as their inspiration, says John Stremlau, a former U.S. State
Department official who currently heads the international relations department at the University of Witwatersrand in Johannesburg:
"We can't rely on the Americans." The new democracies are looking for a constitution written in modern times and reflecting their
progressive concerns about racial and social equality, he explains. "To borrow Lincoln's phrase, South Africa is now Africa's 'last
great hope'." Much in American law and society troubles the world these days. Nearly all countries reject the United States' right to
bear arms as a quirky and dangerous anachronism. They abhor the death penalty and demand broader privacy protections.
Above all, once most foreign systems reach a reasonable level of affluence, they follow the Europeans in
treating the provision of adequate social welfare is a basic right. All this, says Bruce Ackerman at Yale University Law
School, contributes to the growing sense that American law, once the world standard, has become "provincial." The United States'
refusal to apply the Geneva Conventions to certain terrorist suspects, to ratify global human-rights treaties such as the innocuous
Convention on the Rights of the Child or to endorse the International Criminal Court (coupled with the abuses at Abu Ghraib and
Guantanamo) only reinforces the conviction that America's Constitution and legal system are out of step with the rest of the world.
THREE—US markets only lead to unregulated foreign markets- corruption,
institutional capability
Jha, 6 -- Postgraduate Institute of Medical Education & Research nephrology professor
[Vivekanand and Kirpal Chugh, Chandigarh, India, "The case against a regulated system of living kidney sales," Nature Clinical
Practice Nephrology (2006) 2, 466-467, www.nature.com/nrneph/journal/v2/n9/full/ncpneph0268.html, accessed 8-28-14]
Enforcement of current transplantation legislation is uneven in many countries. The presence of illegal middlemen or brokers is not
doubted.8 There have been allegations of active collusion of transplant surgeons, nephrologists and members of the regulatory
bodies in facilitating commercial transplantations, often with the help of forged documents, and the failure of the law in preventing
this activity is well-documented.11, 12 A charitable view could be that these transplantations are performed out of a sense of pity for
the recipients; however, there is a strong suspicion that financial gain is the main motivation. It is hard to imagine that in
societies where there is a combination of desperate individuals, greedy and unscrupulous facilitators and poorly
developed justice systems, transplantation would remain untouched by all-pervasive corruption.
Schemes for setting up government-funded and regulated paid kidney donation programs that give equal
opportunity to rich and poor people, and guarantee health care to the donors, have been proposed. Getting such
programs to work, however, would be a major challenge. Even the proponents of regulated sales concede that
such models can apply only to Western countries that have well-established systems of
implementation and monitoring to ensure fair and equitable distribution through existing
domestic networks. Inherent in such schemes is the assumption that strict geographical containment is possible. Once the
initial rush of domestic donors is exhausted, the globalization of organ trade, whereby donors would come in large numbers from the
developing world to supply organs to the industrialized world, is inevitable. The acceptance of even a limited domestic organ market
in the advanced nations will act as the proverbial thin end of the wedge and encourage adoption of commercial donation in the
developing world. This view was endorsed by the National Kidney Foundation in a testimony to the US Congress where Dr Francis
Delmonico argued that "...a US congressional endorsement for payment would propel other countries to
sanction unethical and unjust standards...". Paid transplantations negatively affect living related and cadaveric
transplantation in developing countries.13 When cheap organs are available, people often opt to buy one rather than subject a loved
one to the risk of donation. There are other strategies apart from organ sales that can increase donation rates, such as public
awareness campaigns, a 'presumed consent' law, use of marginal donors and performing ABO-incompatible or paired-exchange
transplantations. An element of reciprocity could also be injected into the system, so that—for example—people can choose to
donate organs only to those who have in turn indicated their willingness for the same. The arguments supporting a
regulated organ market are extremely simplistic, and ignore the ground realities. Allowing such an
activity in any corner of the world would open the doors for rampant exploitation of the underprivileged
in areas that are already plagued by vast economic inequalities. It is important that the transplant community
approaches this issue with a sense of responsibility towards society that is equal to the compassion it shows towards its patients.
FOUR—balloon effect guts solvency
Dillard-Wright, 12
(David, Assistant Professor of Philosopy at University of South Carolina Aiken “Life, Transferable: Questioning the CommodityBased Approach to Transplantation Ethics,” 3-2-12,
http://scholarcommons.sc.edu/cgi/viewcontent.cgi?article=1002&context=aiken_history_politicalscience_philosophy_facpub,
accessed 7-23-14 //Bosley)
Countries that serve as sources for illicit organs (stolen organs as well as those harvested through cash payments) include places
as diver se as China, Brazil, India, Pakistan, Russia, Moldova, and Romania (among others) with most recipients of organs coming from
the United States, Europe , and Israel (Goyal et al, 2002; Goodwin 2006, p. 11; Rohter, 2004; Scheper - Hughes , 2005). Indeed, “[t]here is now no country
that is unaffected in some way or other by this trade,” (Berthillier , 2003, p. 161). Surgical facilities in Eastern Europe, Turkey, South
Africa, and South America, and other countries hos t the illegal surgeries , with surgeons in Ea stern Europe making “a „mere‟ 400,000 to 500,000 euros [on] four to five
operations being carried out ... in one night,” of which donors can expect to see two or three thousand or perhaps even less (Berthillier 2003, 165). Procurement of organs has
a crackdown in one country simply leads “recruiters” to
go to another unstable part of the world . In this respect, the market in human organs resembles the
emerging human slavery problem an d the legal, though exploitative international labor market. Regulation in one country
simply shifts the burden elsewhere, and few protections exist to curtail the problem on an
international level. In most parts of the world, paying for human organs is already illegal, but this does not stop the trade from taking place. Arrests or manhunts
ties to organized crime, and the problem is exacerbated by the fact that
for surgeons and “donors” have taken place, notably Israeli kidney broker Ilan Peri, who was charged with tax evasion, and the Interpol manhunt for Amit Kumar, a tr afficker
based in Calgary and harvesting organs in India (Rohter, 2004; Yelaja 2008; Nanda 2008).
FIVE—plan collapses anti-trafficking cred- that’s key
Caplan, 14 – NYU bioethics division head and professor
[Arthur, Ph.D. in the history and philosophy of science from Columbia, Drs. William F and Virginia Connolly Mitty Professor and head
of the Division of Bioethics at New York University Langone Medical Center in New York City, "Reply to Cherry," Contemporary
Debates in Bioethics, google books, 70-71, accessed 8-18-14]
Even worse, many Annas will live in other nations who will emulate our decision to permit markets . Those
Annas will have even less potential for choice and will simply be coerced, bullied, threatened, or forced
into kidney sales. When a market opens in the United States, it also opens in far less lawful and far more
impoverished parts of the globe. Since our ability to combat trafficking for organs, sex, baby sales, and
indentured slave labor depends on the moral position that incentives in these domains are wrong, it is a
bitter price to pay to allow a few Annas in the US to sell what will be forced from many, many more
in other parts of the world.
**solvency
Regs Fail: 1NC [1]
Regulations fail- global experience proves circumvention
Scheper-Hughes, 3 – UC Berkeley Medical Anthropology professor
[Nancy, Director of Organs Watch, Francis L. Delmonico, Director of the Renal Transplantation Unit at Massachusetts General
Hospital, the medical director at the New England Organ Bank, and Professor of Surgery at Harvard Medical School, "Why We
Should Not Pay for Human Organs," Zygon, 38(3), Sept 2003,
www.homeworkmarket.com/sites/default/files/why_we_should_not_pay_for_human_organs.pdf, accessed 8-27-14]
Proponents of organ sales suggest that a distribution system regulated with government oversight would
prevent these widely known abuses from occurring, at least in the United States. However, the debate then moves to another
arena for public policy makers to consider. Would a system regulated by the Department of Health and Human Services
(DHHS) accomplish its objectives and become the only route of organs for payment? This is
doubtful in view of the futility of regulated control of donor payments suggested by current practice
elsewhere. The global market sets the value based on social, economic, and consumer-oriented prejudices, such that in todays
kidney market an Indian kidney fetches as little as $ 1,000, a Filipino kidney $ 1,300, a Moldovan or Romanian kidney $2,700, while
a Turkish seller can command up to $10,000 and an urban Peruvian as much as $30,000 (Scheper-Hughes 2002a, 73; 2002b).
Brokering in the United States would likely be no different. If the current policy of prohibition of organ sales
was rescinded, there would be little justification, legally or ethically, to prevent donors from
circumventing the DHHS system and using the Internet to solicit a better price. A regulated system would
either have to outlaw Internet bidding and set a controlled price or would have to continuously modify the price to outbid Internet
brokers and to keep up with emerging kidney markets elsewhere.
Util Good
Default to consequences—anything else is tautological and irrational
Joshua Greene, Associate Professor, Harvard University, “The Secret Joke of Kant’s Soul,” 20 10,
www.fed.cuhk.edu.hk/~lchang/material/Evolutionary/Developmental/Greene-KantSoul.pdf
What turn-of-the-millennium science is telling us is that human moral judgment is not a pristine rational enterprise,
that our moral judgments are driven by a hodgepodge of emotional dispositions, which themselves were shaped by a hodgepodge
of evolutionary forces, both biological and cultural. Because of this, it is exceedingly unlikely that there is any
rationally coherent normative moral theory that can accommodate our moral intuitions. Moreover, anyone who
claims to have such a theory, or even part of one, almost certainly doesn't. Instead, what that person probably has is a moral
rationalization. It seems then, that we have somehow crossed the infamous "is"-"ought" divide. How did this happen? Didn't Hume
(Hume, 1978) and Moore (Moore, 1966) warn us against trying to derive an "ought" from and "is?" How did we go from descriptive
scientific theories concerning moral psychology to skepticism about a whole class of normative moral theories? The answer is that
we did not, as Hume and Moore anticipated, attempt to derive an "ought" from and "is." That is, our method has been inductive
rather than deductive. We have inferred on the basis of the available evidence that the phenomenon of rationalist deontological
philosophy is best explained as a rationalization of evolved emotional intuition (Harman, 1977). Missing the Deontological Point I
suspect that rationalist deontologists will remain unmoved by the arguments presented here. Instead, I suspect, they will insist that I
have simply misunderstood whatKant and like-minded deontologists are all about. Deontology, they will say, isn't about this
intuition or that intuition. It's not defined by its normative differences with consequentialism. Rather, deontology is about taking
humanity seriously. Above all else, it's about respect for persons. It's about treating others as fellow rational creatures rather
than as mere objects, about acting for reasons rational beings can share. And so on (Korsgaard, 1996a; Korsgaard, 1996b).This is,
no doubt, how many deontologists see deontology. But this insider's view, as I've suggested, may be misleading. The problem,
more specifically, is that it defines deontology in terms of values that are not distinctively deontological,
though they may appear to be from the inside. Consider the following analogy with religion. When one asks a religious person to
explain the essence of his religion, one often gets an answer like this: "It's about love, really. It's about looking out for other people,
looking beyond oneself. It's about community, being part of something larger than oneself." This sort of answer accurately captures
the phenomenology of many people's religion, but it's nevertheless inadequate for distinguishing religion from other things. This is
because many, if not most, non-religious people aspire to love deeply, look out for other people, avoid self-absorption, have a sense
of a community, and be connected to things larger than themselves. In other words, secular humanists and atheists can assent to
most of what many religious people think religion is all about. From a secular humanist's point of view, in contrast, what's distinctive
about religion is its commitment to the existence of supernatural entities as well as formal religious institutions and doctrines. And
they're right. These things really do distinguish religious from non-religious practices, though they may appear to be secondary to
many people operating from within a religious point of view. In the same way, I believe that most of the standard
deontological/Kantian self-characterizatons fail to distinguish deontology from other approaches to ethics. (See also Kagan (Kagan,
1997, pp. 70-78.) on the difficulty of defining deontology.) It seems to me that consequentialists, as much as anyone else, have
respect for persons, are against treating people as mere objects, wish to act for reasons that rational creatures can share, etc. A
consequentialist respects other persons, and refrains from treating them as mere objects, by
counting every person's well-being in the decision-making process. Likewise, a consequentialist attempts to act
according to reasons that rational creatures can share by acting according to principles that give equal
weight to everyone's interests, i.e. that are impartial. This is not to say that consequentialists and deontologists don't
differ. They do. It's just that the real differences may not be what deontologists often take them to be. What, then, distinguishes
deontology from other kinds of moral thought? A good strategy for answering this question is to start with concrete disagreements
between deontologists and others (such as consequentialists) and then work backward in search of deeper principles. This is what
I've attempted to do with the trolley and footbridge cases, and other instances in which deontologists and consequentialists
disagree. If you ask a deontologically-minded person why it's wrong to push someone in front of speeding trolley in
order to save five others, you will getcharacteristically deontological answers. Some will be tautological: "Because it's
murder!"Others will be more sophisticated: "The ends don't justify the means." "You have to respect people's rights." But, as we
know, these answers don't really explain anything, because if you give the same people (on different occasions) the trolley case or
the loop case (See above), they'll make the opposite judgment, even though their initial explanation concerning the footbridge case
applies equally well to one or both of these cases. Talk about rights, respect for persons, and reasons we can share are natural
attempts to explain, in "cognitive" terms, what we feel when we find ourselves having emotionally driven intuitions that are odds with
the cold calculus of consequentialism. Although these explanations are inevitably incomplete, there seems to be "something deeply
right" about them because they give voice to powerful moral emotions. But, as with many religious people's accounts of what's
essential to religion, they don't really explain what's distinctive about the philosophy in question.
Big impacts are probable card
Cognitive bias against existential risk – err neg
Nick Bostrom, Professor, Oxford and Director, Future of Humanity Institute, “We’re Underestimating the Risk of Human
Extinction,” Interviewed by Ross Andersen, THE ATLANTIC, 3—6—12,
www.theatlantic.com/technology/archive/2012/03/were-underestimating-the-risk-of-human-extinction/253821/
You have argued that we underrate existential risks because of a particular kind of bias called observation
selection effect. Can you explain a bit more about that? Bostrom: The idea of an observation selection effect is maybe
best explained by first considering the simpler concept of a selection effect. Let's say you're trying to estimate how large the
largest fish in a given pond is, and you use a net to catch a hundred fish and the biggest fish you find is three inches long. You
might be tempted to infer that the biggest fish in this pond is not much bigger than three inches, because you've caught a
hundred of them and none of them are bigger than three inches. But if it turns out that your net could only catch fish up to a
certain length, then the measuring instrument that you used would introduce a selection effect: it would only select from a
subset of the domain you were trying to sample. Now that's a kind of standard fact of statistics, and there are methods for
trying to correct for it and you obviously have to take that into account when considering the fish distribution in your pond. An
observation selection effect is a selection effect introduced not by limitations in our measurement instrument, but rather by the
fact that all observations require the existence of an observer. This becomes important, for instance, in evolutionary biology.
For instance, we know that intelligent life evolved on Earth. Naively, one might think that this piece of evidence suggests that
life is likely to evolve on most Earth-like planets. But that would be to overlook an observation selection effect. For no matter
how small the proportion of all Earth-like planets that evolve intelligent life, we will find ourselves on a planet that did. Our data
point-that intelligent life arose on our planet-is predicted equally well by the hypothesis that intelligent life is very improbable
even on Earth-like planets as by the hypothesis that intelligent life is highly probable on Earth-like planets. When it comes
to human extinction and existential risk, there are certain controversial ways that observation selection
effects might be relevant. How so? Bostrom: Well, one principle for how to reason when there are these observation
selection effects is called the self-sampling assumption, which says roughly that you should think of yourself as if you were a
randomly selected observer of some larger reference class of observers. This assumption has a particular
application to thinking about the future through the doomsday argument, which attempts to show
that we have systematically underestimated the probability that the human species will perish
relatively soon. The basic idea involves comparing two different hypotheses about how long the human species will last in
terms of how many total people have existed and will come to exist. You could for instance have two hypothesis: to pick an
easy example imagine that one hypothesis is that a total of 200 billion humans will have ever existed at the end of time, and
the other hypothesis is that 200 trillion humans will have ever existed. Let's say that initially you think that each of these
hypotheses is equally likely, you then have to take into account the self-sampling assumption and your own birth rank, your
position in the sequence of people who have lived and who will ever live. We estimate currently that there have, to date, been
100 billion humans. Taking that into account, you then get a probability shift in favor of the smaller hypothesis, the hypothesis
that only 200 billion humans will ever have existed. That's because you have to reason that if you are a random sample of all
the people who will ever have existed, the chance that you will come up with a birth rank of 100 billion is much larger if there
are only 200 billion in total than if there are 200 trillion in total. If there are going to be 200 billion total human beings, then as
the 100 billionth of those human beings, I am somewhere in the middle, which is not so surprising. But if there are going to be
200 trillion people eventually, then you might think that it's sort of surprising that you're among the earliest 0.05% of the
people who will ever exist. So you can see how reasoning with an observation selection effect can have these surprising and
counterintuitive results. Now I want to emphasize that I'm not at all sure this kind of argument is valid; there are some deep
methodological questions about this argument that haven't been resolved, questions that I have written a lot about. See I had
understood observation selection effects in this context to work somewhat differently. I had thought that it had more to do with
trying to observe the kinds of events that might cause extinction level events, things that by their nature would not be the sort
of things that you could have observed before, because you'd cease to exist after the initial observation. Is there a line of
thinking to that effect? Bostrom: Well, there's another line of thinking that's very similar to what you're describing that speaks
to how much weight we should give to our track record of survival. Human beings have been around for roughly a hundred
thousand years on this planet, so how much should that count in determining whether we're going to be around another
hundred thousand years? Now there are a number of different factors that come into that discussion, the most important
of which is whether there are going to be new kinds of risks that haven't existed to this point in
human history---in particular risks of our own making, new technologies that we might develop this century,
those that might give us the means to create new kinds of weapons or new kinds of accidents. The fact that we've been
around for a hundred thousand years wouldn't give us much confidence with respect to those risks. But, to the extent that one
were focusing on risks from nature, from asteroid attacks or risks from say vacuum decay in space itself, or something like
that, one might ask what we can infer from this long track record of survival. And one might think that any species anywhere
will think of themselves as having survived up to the current time because of this observation selection effect. You don't
observe yourself after you've gone extinct, and so that complicates the analysis for certain kinds of risks.
1NC Exploitation Turn
Legal sales cause widespread suffering, economic ruin and structural violence
Moniruzzaman, 14 - Department of Anthropology and Center for Ethics and Humanities in Life Sciences, Michigan State University
(Monir, “Regulated Organ Market: Reality Versus Rhetoric” October, Volume 14, Number 10, 2014)
selling an organ does not alleviate the sellers’ poverty. In my study, 81% of
organ sellers did not receive the payment they were promised. For example, Koliza, a liver seller, received
150,000 Taka (US$1,875), only half the amount the broker had promised him. Proponents of the organ market
therefore argue that a regulated system could offer full payment for the sellers (though the Iranian
regulated market proves otherwise; Zargooshi 2001), yet these proponents fail to explain how the
payment (if it is paid in full) ensures income-generating opportunities for impoverished populations.
Here, Koplin aptly argues that an organ market could not compensate for the extensive harms and
ensure long-term benefits for vendors’ overall well-being. My research cultivates Koplin’s claim by capturing that
To make matters worse,
Bangladeshi sellers mostly used their money to pay off their microloans; buy material goods, such as a cell phone, a television, or
Once the money had nearly run out, most
sellers had already lost their jobs . Some managed to get new jobs, but their damaged bodies
impeded their abilities to continue to do physically demanding jobs , such as rickshaw pulling, manual farm
gold jewelry; or arrange a dowry or medical treatment for their family.
work, or day laboring. As Koliza summarizes, by selling a kidney, a person damages not only himself, but also his family, noting that
“three of my family members were depending on my income, and now I am done, and so are they.” As a result, some sellers
have turned to organ brokering; they prey on their families, neighbors, and villagers just to get by.
My research also finds that many sellers entered the organ market to pay off their debts, but soon
were back in debt (see Cohen 2003). For example, Koliza took out new microcredit loans to start a poultry farm a year after
selling his liver lobe. With a chicken mortality rate as high as 50%, at the return of his microcredit debt Koliza remarked, “I no longer
have other parts to spare.” A regulated organ market could not ensure the long-term economic benefits
of organ sellers, but rather might corrupt the overall situation . My recent fieldwork reveals that
moneylenders have pressured the poor to sell their spare organs to repay loans. Husbands have tricked
or forced their wives to sell their organs for economic gain (in one case, a man married twice to profit from the sale of his wives’
kidneys, and in another case, a man sold his wife’s kidney after claiming to take her to the hospital for an appendectomy). A 6-yearold boy was murdered by an organ trafficking racket and his body tossed in a pond after both kidneys were removed (The Daily Star
2014). I also document that four members of one family (a father, two brothers, and a daughter-in-law) each sold a kidney. Buyers
regularly publish organ classifieds in major newspapers for soliciting organs, and brokers have expanded their networks from local
to national to international levels. Such
profound violence, exploitation, and suffering would be rife in the
regulated or rampant commerce of organs.
In sum, after selling their vital organs, the health of sellers is compromised, their economic
situation has worsened, and their social status has declined (Moniruzzaman 2012). The outcomes of
organ selling are invasive, harmful, and devastating. As seller Koliza said with regret, “I donated my liver lobe to: i)
live better, ii) save a life, and iii) satisfy God. In the end, my recipient died after a month and I could not escape the clutches of
poverty. If I had a second chance in life, I would not sell my body parts, nor let others die inside out from it.”
It can therefore be argued that a
regulated organ market is not the solution, but rather, the strict
criminalization of the organ trade is ethically and pragmatically essential . As Koplin notes, a
regulated organ market would improve vendors’ well-being or minimize their harms lack evidential warrant. Such a system
does not speak to the lives of the economic underclass, but rather seriously discriminates against
them. It promotes the value of individual autonomy, but puts minimal emphasis on beneficence and justice to organ sellers. We
ought to oppose the organ market in order to curb this illicit practice.
Disease
That wrecks effective response to disease outbreak
Carly Ruderman 6, Primary Care Research Unit, Department of Family and Community Medicine, Sunnybrook Health
Sciences Centre, “On pandemics and the duty to care: whose duty? who cares?” BMC Medical Ethics 2006, 7:5,
http://www.biomedcentral.com/1472-6939/7/5
The ethical foundations of the duty to provide
care are grounded in several longstanding ethical principles. Foremost among these is the principle
of beneficience, which recognizes and defines the special moral obligation on the part of HCPs [Health Care
Professionals] to further the welfare of patients and to advance patients' well-being . In modern health care, it
Do health care professionals have special obligations during infectious disease outbreaks?
is commonly understood and generally accepted that the principle of beneficence constitutes a foundational principle of the patient-provider relationship [15]. For the HCP in
general, and for the physician in particular, there are a number of compelling reasons to provide care in the context of an infectious disease outbreak. Clark [12] has recently
outlined three such reasons: 1. The ability of physicians and health care professionals to provide care is greater than that of the public, thus increasing the obligation to provide
it is evident
that the expertise of HCPs is an integral and principal component of the response to a pandemic .
There is no other sector of society that can be legitimately expected to fulfil this role and to assume this level of risk. 2.
care Although self-care and self-protection, as well as the care and protection of friends and family members, are acknowledged in pandemic plans,
By freely choosing a profession devoted to care of the ill, health care professionals have assumed risk Arguably, HCPs have consented to greater than average risk by their
very choice of profession. While it may be granted that the risk of contracting an infectious disease was likely not a concern for a generation of prospective health care workers,
medical literature in the last 20 years has shown that infectious diseases remain
ubiquitous and problematic – notwithstanding overly-optimistic statements regarding the future threat of infectious diseases. It is therefore not
unreasonable to argue that HCPs were aware of the greater than average risks posed by their choice of profession. 3. The profession is legitimated
by social contract and therefore its members should be available in times of emergency In publiclyfunded health care systems, such as those found in many Western societies, there is a strong claim for a social contract
between the HCP and society. It is a reasonable and legitimate expectation by the public that HCPs will respond in an infectious disease emergency.
Society has granted and permits professions to be self-regulating on the understanding that such a response would occur.
any informed reading of the
The role of professional codes of ethics One of the characteristics of a self-regulating profession is the development of standards of practice, sometimes referred to as best
practice guidelines. These standards are articulated in professional codes of ethics, which are developed on the basis of the fundamental principles and values of the particular
profession, as is the case, for instance, with respect to the codes of ethics that were developed long ago in medicine and nursing. Indeed, the code of ethics has a long and
respected tradition in the health professions and today most, if not all, the various health and social care professions have codes of ethics in place to provide guidance to their
in the health care
professions, codes of ethics should be interpreted as guides for ethical reasoning and frameworks for
the treatment of individual patients, rather than as substitutes for such reasoning or as an absolute mandate [17]. At the same time, a code
that is too vague can render it ineffectual and irrelevant . In an era in which health care and technology are evolving at a rapid
pace, efforts are necessary to ensure that codes of ethics remain current, practical, and concordant with public expectations. An informative and comprehensible code of
ethics has numerous tangible benefits . Perhaps the greatest benefit would be to dispel confusion and
uncertainty for HCPs concerning their professional rights and responsibilities as regards the duty to
care . Of course, a detailed treatment of the issue in professional codes of ethics would also serve to increase awareness and comfort levels, perhaps resulting in increased
members. The code of ethics is sometimes referred to as an instrument of "soft law," owing to its non-legislative nature [16]. As such,
willingness to provide care in uncertain and risky conditions [18]. Additionally, codes guiding professional conduct may effectively serve as norms of standards recognizable and
codes of ethics also serve as potent forms of
symbolic communication to the public that is served by the professions. By making explicit the values that health care
professions represent, professional codes of ethics can reassure the public that the trust invested in the
professions is justified and legitimate , as is properly noted in the following excerpt from the College of Nurses of Ontario Practice Standard on
enforceable by law, acting as the foundation of legal obligations and decisions [16]. Finally,
Ethics:
2NC
CP
Frontline – Solv/NB
Effect is same- tax system=incentive
Milot, 8 -- University of Georgia law professor
[Lisa, Willamette Law Review, "The Case Against Tax Incentives for Organ Transfers," Fall 2008, 45 Willamette L. Rev. 67, l/n,
accessed 8-31-14]
Tax incentives are not seen as less problematic in this regard than direct payments for body parts because the net practical effect
differs; after all, the net effect of both direct payments and tax incentives is to financially encourage organ donations. Tax
incentives simply seem less commercial and for this reason are more acceptable. In comparing tax
expenditures to direct payments, Professors David A. Weisbach and Jacob Nussim explain that, at times, Endowment effects
[may] make
expenditures through the tax system less visible than direct expenditures. People may
perceive a reduction in taxes for engaging in a specified activity differently from an identical
direct grant: They may perceive a tax subsidy as merely letting them keep their money, even while they perceive an identical
program that taxes them and gives the money back through programs or services to be a subsidy. n114 Professors Weisbach and
Nussim focus on the potential good publicity around enacting a government spending program, and conclude that the difference in
visibility "may actually lead to a legislative preference for direct spending over tax programs rather than the other way around." n115
They note that in some cases, however, this "lack of visibility may be a good, rather than a bad, thing." n116 If a
program is desirable but individuals tend to resist it, "putting it into the tax system could reduce
opposition by making it invisible due to framing effects." n117 It is this relative invisibility of tax
expenditures that makes the approach so attractive to some legislators and scholars when
compared to direct payments for organs. To the extent the expenditure can be framed in terms of
a reimbursement or can be analogized to the existing deduction for charitable contributions, it
avoids the labels of "commodification" and "market," even though [*88] the net effect of the
incentive is the same to the taxpayer. n118 Thus, use of the tax system to provide the incentive
could prove more effective at obtaining the organs needed for transplant by allowing donors to feel
like what they are doing is donating, not selling. This might be desirable where the end result
(provision of additional organs) is seen as a societal good, but the means (through compensation)
is contested.
Tax credits solve the case and avoid backlash
Kahan, 9 -- J.D. 2010, Magna Cum Laude, Hofstra University School of Law
[Sara, "Incentivizing Organ Donation," Hofstra Law Review, 38 Hofstra L. Rev. 757, Winter 2009, l/n, accessed 8-31-14]
B. Indirect
Financial Incentives
As an alternative to providing direct payments for organ donations, other forms of payment may be
offered as incentives to donate. Although these incentives would not place cash directly into the
hands of the donor or the donor's estate, they would help ease some other financial burdens
associated with organ donation. n264 Indirect incentives distance the economic benefit from the decision
to donate, eliminating many of the concerns opponents have with the sale of organs . n265 1.
Reimbursement for the Medical Care and Funeral Expenses of Cadaveric Donors At the very least, families of cadaveric donors
should receive reimbursement for the medical care and/or funeral expenses of the donor. The following true story exemplifies the
fundamental unfairness of the current transplant system: The mother of Susan Sutton, a twenty-eight year old female who took her
own life, made the decision to donate her daughter's organs. n266 Her heart and liver saved lives, her corneas gave sight, her
bones were used for reconstructive surgery, and her skin provided grafts for burn victims. n267 Not only were the recipients of her
tissue and organs given a prolonged and improved quality of life, but both the doctors and the hospitals performing the transplants,
as well as the organ procurement agency, profited from her donation. n268 Susan, however, was buried in an unmarked grave
because her mother was unable to afford a gravestone and the law prohibited her from donating her daughter's organs in exchange
for a proper burial. n269 In 1994, Pennsylvania sought to remedy this inequity by enacting a Death Benefits Program. n270 The Act
created the Organ Donation Awareness Fund. n271 The fund, supported by $ 1 donations from Pennsylvania residents, reimbursed
a cadaveric donor's estate up to $ 3,000 for "reasonable hospital and other medical expenses, funeral expenses, and incidental
expenses incurred by the donor or donor's [*789] family in connection with making a vital organ donation." n272 In order to ensure
that the transfer of money was not made directly to the donor's estate, payments could "only be made directly to the funeral home,
hospital or other service provider related to the donation." n273 This system silenced many opponents of an incentive-based system
of organ procurement as it prevents individuals and corporations from capitalizing on the sale of organs and preserves the altruistic
nature of organ donation. n274 Unfortunately, in 2002, the Pennsylvania Department of Health held that these benefits came too
close to violating NOTA's prohibition against offering valuable consideration for the purchase or sale of organs, and reduced donor
reimbursement to $ 300. n275 The remainder of the fund now goes toward organ donation awareness programs. n276 Despite
critique that $ 300 creates little incentive to donate, during the first six months of the revised Death Benefits Plan, nineteen donor
families applied for the $ 300 donation benefit. n277 Further, the number of Pennsylvanians carrying an identification card
designating them as an organ donor increased by 0.5%, making an additional 83,344 Pennsylvania citizens potential cadaveric
organ donors. n278 Thus indirect financial incentives, at least in Pennsylvania, have proven to be a successful method of increasing
the potential donor pool. 2. Tax Benefits Tax benefits for organ donors, living or cadaveric, is another reasonable
alternative to direct compensation. n279 Many states, Wisconsin being the first, have adopted legislation granting tax
deductions to living organ donors. n280 Wisconsin allows for a maximum deduction of $ 10,000 from adjusted gross income for
costs incurred from donating all or part [*790] of a liver, kidney, pancreas, intestine, lung, or bone marrow. n281 This deduction may
be claimed for all donation related expenses that are not covered by insurance, such as travel, lodging, and lost wages. n282
Currently, this incentive is only available to living donors. n283 Under my proposal, tax benefits can easily be made available to
cadaveric donors by offering a tax credit to the donor's estate. n284 Other indirect financial incentives to donate can include a life
insurance policy for live donations, a gift to the donor's charity of choice, n285 or college tuition credits for the survivors of cadaveric
donors. n286 Compensation does not need to be proportional to the estimated monetary value of the
donated organ in order to afford adequate incentive to donate. Those already inclined to donate
may be encouraged to complete a donor card when given a slight external motivator . n287
Solvency – Doctors
Doctors hate cash payments- love tax credits
Satel, 10 – MD, American Enterprise Institute Resident Scholar
[Sally, Psychiatric consultant PIDARC (Partners in Drug Abuse Rehab and Counseling), “The Physicians’ Voice Is Only One of
Many,” American Journal of Transplantation, Wiley Online Library, accessed 8-31-14]
As for physician opinion, Segev and Gentry relate only half of the story. True, a mere one-fifth of physician respondents to
an ASTS poll endorsed cash payments to donors (1). Unmentioned, however, is the highly significant fact
that 64% of respondents favored income tax credits to living donors (12% were neutral or undecided). This finding
has critical policy relevance because it is regulated in-kind benefits, such as tax credits, not free market cash exchange,
that have long been the basis for serious reform efforts in Congress and in state legislatures. Notably, the American Medical
Association has endorsed proposals for pilot trials on three occasions between 1995 and 2008 (1995, 2003 and 2008) (3).
Try or die neg- doctors key
Segev, 10 -- Johns Hopkins professor of surgery
[Dorry, MD, PhD, and S.E. Gentry, Department of Epidemiology, Johns Hopkins School of Public Health, Department of
Mathematics, United States Naval Academy, "Kidneys for Sale: Whose Attitudes Matter?," American Journal of Transplantation,
2010, 10, 1113-1114, ebsco, accessed 8-27-14]
nothing else is relevant until physicians support organ sales. And , right now, they don't . In a
recent survey of the American Society of Transplant Surgeons, only 20% of transplant surgeons-those actually
doing the transplants-supported cash payments for deceased or live donation (2). Similar lack of support was found
among physicians from other societies as well (3). Clearly an organ market will not be much of a market with so
few willing to perform the transplants or refer the patients. And a rift in the transplant community
resulting from a marginally sup- ported organ market will likely be much more detrimental to
organ transplantation in the United States than any putative increase in donation from establishing
financial incentives (4). As such, those seeking to better understand the viability of organ markets
should focus first on the physicians.
First,
A2 States Fail
State tax credits fail because of NOTA- uniform legalization solves
Derco, 10 -- J.D. Candidate, The Catholic University of America, Columbus School of Law
[Lisa, "America's Organ Donation Crisis," Journal of Contemporary Health Law & Policy, 27 J. Contemp. Health L. & Pol'y 154, Fall
2010, l/n, accessed 8-31-14]
Under OTPA, the states have broad discretion to determine what incentives to offer in order to increase organ donation. One
example is to issue tax breaks to donors. This method was enacted in Wisconsin in 2004, and allowed a state
income tax deduction of up to $ 10,000 to cover the expenses a donor may face. n120 Many critics of the bill, including Howard
M. Nathan, President and Chief Executive of the Gift of Life Donor Program, n121 say that the $ 10,000 incentive violates
NOTA. n122 Conversely, proponents, including former State Representative Steve Wieckert, n123 argue that such deductions
merely remove the financial obstacles preventing many people from becoming donors. n124 Kansas considered similar legislation in
2000, but the state attorney general believed that the legislation would violate NOTA and, as a result, it was never passed. n125
This disagreement demonstrates the [*176] inconsistency in the states' understanding of the
meaning of valuable consideration under NOTA, and the need to clarify what is permissible in
order to increase the number of organ donors.
A2 PDCP
Sale requires ownership- aff establishes a property right for organs that the
counterplan doesn’t
Fuentes, 8 -- US Court of Appeals Third Circuit judge
[Julio, THE BUSINESS EDGE GROUP, INC., Appellant, v. CHAMPION MORTGAGE COMPANY, INC., No. 07-1059, 3-11-8, l/n,
accessed 9-1-14]
C. Defining
Sale
The District Court concluded that the 1999 Agreement was a contract for the sale of the Number and thus violated 47
C.F.R. § 52.107. We disagree. First, we note that subscribers do not "own" toll free telephone numbers . In the Matter
of Toll Free Service Access Codes, 20 F.C.C.R. 15089, 15090 P 4, 2005 WL 2138620, at *2 (F.C.C. Sept. 2, 2005) ("Telephone numbers are a public
resource and neither
carriers nor subscribers 'own' their telephone numbers."). Because subscribers do
not own their telephone numbers, they can never "sell" them outright. [**10] Instead, they "sell" the interest that they
have in the number; that is, the right to use it to provide toll free service. In order to determine whether the 1999 Agreement
constituted a sale for the purposes of 47 C.F.R. § 52.107, we review dictionary definitions of "sale" and "sell" to
assess whether the agreement falls within the definitions. Black's Law Dictionary (8th ed. 2004) ("Black's") defines
"sale" as "[t]he transfer of property or title for a price," id. at 1364, and defines "sell" as "[t]o [*155] transfer (property) by sale," id. at 1391. Black's
defines "transfer" as "[a]ny mode of disposing of or parting with an asset or an interest in an asset." Id. at 1535. Meanwhile, Merriam-Webster's Online
Dictionary defines "sale" as "the act of selling; specifically: the transfer of ownership of and title to property from one person to another for a price" and,
in relevant part, defines "sell" as "to give up (property) to another for something of value (as money)." Id. at http://www.merriam-websters.com (last
visited Feb. 12, 2008). Next, Random House Webster's Unabridged Dictionary ("Webster's") defines "sale," in relevant part, as a "transfer of property
for money or credit," id. at 1693, [**11] and "sell," in relevant part, as "to transfer (goods) to or render (services) for another in exchange for money;
dispose of to a purchaser for a price," id. at 1739. Webster's defines "dispose of," in relevant part, as "to transfer or give away, as by gift or sale." Id. at
568. Without
exception, these definitions of "sale" and "sell" emphasize the transfer of property or
ownership for a price
and the finality of the transaction. Here, the fundamental features of the 1999 Agreement were that Business Edge
retained control of the Number, preserving responsibility for paying toll charges, and that Business Edge would only perform routing services for a
period of five years. We, therefore, cannot conclude that the 1999 Agreement was a sale. Therefore, we vacate the District Court's decision that the
1999 Agreement should be invalidated for violating the prohibition on selling toll free telephone numbers in 47 C.F.R. § 52.107.
Tax credits are not sales- the organ is not given a price
Abrahams, 9 -- lawyer and former law professor
[Harlan, former tenured professor at the University of Puget Sound School of Law, "The Organ Markets Come to America," 2009,
Swing Vote, www.swingvotemag.com/Magazine/commentaries/SVC_The_Organ_Markets2009-10-06.php, accessed 8-31-14]
NOTA prohibits the buying and selling of human organs for transplantation purposes. Ironically cadaveric
organs can be bought and sold for research purposes -- but not to save a life. The prohibition has been amended to allow for
"kidney swaps" and other innovative means of bringing willing donors and recipients together, and further amendments have been
proposed. But none allow for the outright purchase and sale of an organ. The Rosen case is instructive. He says he got
$20,000 for his kidney. In cases
like this, the buyer and seller, whether with or without a broker, bargain for the price of the
kidney itself. This
"free market" system must be carefully distinguished from those alternate systems
often called "compensated" donation, where the States would be allowed to offer non-cash benefits or incentives to
organ donors. Under this system, an organ donor or [their]his family may be given life insurance
benefits, health insurance benefits, tax credits, expanded health care, or other incentives
designed to "compensate" them. There is none of the bargaining between buyers and sellers. The
organ itself is not given a price . While most countries continue to outlaw the sale of transplant organs, the move to
granting more incentives to donors is building. Senator Arlen Specter has sponsored the Organ Trafficking
Prohibition Act of 2009. This legislation would tighten NOTA's prohibition against the buying and selling of organs for
transplantation while authorizing the States to experiment with non-cash benefits for donors. The draft legislation states
the "provision of a gratuitous benefit to organ donors is not commercial in nature and does not
constitute a commercial sales transaction."
[Matt note: gender-modified]
Distinction between sales and incentives like tax credits is key to precision- key
to transplantation debates
Matas, 10 -- University of Minnesota department of surgery professor and transplant surgeon
[A.J., "Markets or Incentives: Terminology Is Critical," American Journal of Transplantation, 2010, 10:2374, ebsco, accessed 8-2714]
Markets or Incentives: Terminology Is Critical
Opinions on whether or not there should be trials of incentives for donation are strong and the issue is hotly debated. And, for
disclosure, I have been one of the proponents of trials of incentives for living kidney donation. However, whatever the opinion, we
will only be able to have meaningful discussion if we start with the same facts and represent them
accurately. In addition, we need to choose our terminology with care. In that regard, I am disappointed in
Segev and Gentry's Editorial (1) regarding Leider and Roth's survey, which was recently published in The American
Joumal of Transplantation (2). Leider and Roth conducted a survey of public attitudes regarding mar- kets for living and deceased
donation. They found that a majority of respondents approved of either individual or government payment for either living or
deceased dona- tion (although there was considerably stronger support for government payment). Segev and Gentry respond by
noting that a survey of the membership of the American Society of Transplant Sur- geons (ASTS)
showed that only 20% were in favor of 'cash payments' for donation (3). Segev and Gentry are correct. But what
they did not note in their editorial, was that for de- ceased donation, the majority of ASTS respondents were in
favor of funeral expenses (73%), an income tax credit (65%) and about half were in favor of a donation to a
charity selected by the donor's family (51%) and reimbursement of next-of-kin expenses (56%). For living donation,
the ma- jority supported payment of lost wages (76%), payment of health insurance premiums (72%) or an
income tax credit (64%) and 56% supported payment of life insurance pre- miums. Part of the problem with
this debate lies in terminology. Leider and Roth discuss 'sales' and 'markets' in their arti- cle, and Segev
and Gentry follow suit, whereas the ASTS survey discussed potential government sponsored strategies to increase organ
donation. The term 'market' has a specific connotation (and, certainly can become emotion- ally charged when considering a 'free
market' or 'black market' for organs). Yet the vast majority advocates for in- centives argue for a regulated system of incentives
where there is no contact between the donor and recipient, the government (or government agency) provides the incentive for the
donor (and is responsible for evaluation, followup and provision of the incentive), and kidneys are rationed in a way similar to the
current rationing of deceased donor kidneys so that all on the list have an opportunity to be transplanted. It is a disservice to the
debate and discussion to present only part of the ASTS survey results. There are other is- sues with Segev and Gentry's Editorial.
lhey suggest that doing these kinds of public opinion surveys are a waste of resources because: (a) physicians are against
'sales' and (b) to establish trials of 'organ markets' would require changing the law (1). However , using the same survey data
that they quote (see above), (a) physicians are in favor of incentives (and before trials of incentives could be developed
the law would need to be changed) and (b) legislators are certainly going to be more inclined to change the law if the public supports
such a change. Fi- nally, they conclude that the many recent advances in do- nation may solve the tremendous organ shortage
problem, making need for incentives moot. But the data says otheP wise; in spite of laparoscopic nephrectomy, use of ECDs, DCD,
desensitization and paired exchange, there has been little or no increase in donation over the last few years and the wait list for a
kidney transplant has continued to grow (4).
Shortages
Ext2—Crowdout 2NC
Best empirical evidence goes negative
Oliver Decker 14, PhD, Member of the Faculty of Medicine at the University of Leipzig and Reader at the Faculty of Philosophy
at the Leibniz University Hannover, former Visiting Professor for Social and Organizational Psychology at the University of Siegen,
Commodified Bodies: Organ Transplantation and the Organ Trade, google books
the market solution begin less with the ethical than with the factual consequences. According to their prognosis, the latter
undermine the desired remedy for the shortage of raw materials by completely commodifying the human
body . The crucial example of the counterproductive effect of a market solution on the allocation
of organs is blood donation . An investigation of blood donations showed that “where the sale of blood was
allowed, donations declined ” (Tittmus 1971). This sociopsychological finding helps us answer the
question as to how a commercialization of the body affects the willingness to donate out of
altruistic motives. The answer is clear : an “ erosion of motivation ” (Archard 2002, 87) was the result of the
commercialization of trade in blood and can also be expected to be the result in the event of a
legalization of trade in organs. From the Chicago Business School itself comes a serious objection
to an incentive system or an organ market: “ Extrinsic motivation might change the perception of the activity and destroy the
Thus some critics of
intrinsic motivation to perform it when no apparent reward from the activity itself is expected” (Gneezy and Rustichini 2000a, 792). In an experiment in a kindergarten,
parents were fined for being late in picking up their children after school. But the result was only that most
of the parents were late in picking up their children, because now a service was demanded of them. Even after the
experiment was terminated and the fine was no longer levied, the parents continued to come late. In principle, according to the rationale for the experiment, a service
that up to that point had been provided by the children’s caregivers at no cost was now offered in
exchange for money, as a commodity. This was the investigator’s conclusion: when a morally motivated act is replaced by a commercial
motivation, this alters the demand and character of the service, and the moral barriers fall: “Once a commodity, always a commodity” (ibid., 791). The consequence for trade in
organs: if it is begun, it must be done right, because there is no going back: “Pay enough or don’t pay at all” (Gneezy and Rustichini 2000b). There are many such “hidden costs
it seems clear that the relationship to other people is in
fact changed : “the body parts of others become a good to which claims can be made, and the organ donor becomes a simple bearer of
of organ sale” (Rothmann and Rothmann 2006, 1525). In each case
exchange value” (Schneider 2007, 120).
Allowing sales collapses donation, reducing overall supply
Rothman, 6 – Columbia University Public Health professor
[Sheila., and D.J., PhD from Columbia University, Assistant to the Deputy Director of the Center for the Study of Society and
Medicine at the Columbia College of Physicians & Surgeons at Columbia University, "The Hidden Cost of Organ Sale," American
Journal of Transplantation, 6(7), 2-13-06, www.societyandmedicine.columbia.edu/organs_challenge.shtml, accessed 8-27-14]
Ethics has occupied a central place in the debate over the sale of kidneys, with two key principles vying for primacy. Proponents
emphasize the concept of autonomy— the right of persons to sell their body parts, free of heavyhanded paternalism. Opponents
invoke standards of fairness and justice; the poor will sell their kidneys to the rich, engendering systematic exploitation. What has
been relegated to the margins, however, is full consideration of the implications of such a system for medicine and for society.
Proponents flatly assert that sale would increase the supply and not reduce the rate of altruistic donation. They
posit that such a market could be effectively regulated and that sellers would benefit greatly from the financial windfall. But these
claims are not well substantiated and may prove wrong. No less important, they fail to take into account the
many other possible effects of allowing a market in organs (4,5). Because the intended and unintended
consequences of policy change cannot be easily predicted, this analysis is put forward in tentative, even speculative, terms. The aim
is to raise considerations that may have been glossed over, to highlight the possibilities that have not been imagined, and to prompt
second thoughts about postulates that seem obvious. The intent is not to persuade one side or the other that these projections will
inevitably be realized but to encourage both sides to deepen and widen the scope of their concerns. Just as studies of the possible
impact of legislation on the environment are mandated, so the likely impact of legalization of organ sale warrants consideration.
Crowding Out Advocates think it self-evident that market incentives will yield more organs for transplantation. ‘People are more
likely to do something if they are going to get paid for it’ (6). And sellers will not drive out donors. Whatever financial incentives exist,
siblings and parents will continue to donate to loved ones. These expectations, however, may be disappointed. Since
economists and social psychologists have been analyzing the tensions between
‘extrinsic incentives’—financial compensation and monetary rewards, and ‘intrinsic incentives’—
the moral commitment to do one’s duty. They hypothesize that extrinsic incentives can ‘crowd
the 1970s, a group of
out’ intrinsic incentives, that the introduction of cash payments will weaken moral obligations . As
Uri Gneezy, a professor of behavioral science at the University of Chicago School of Business,
observes: ‘Extrinsic motivation might change the perception of the activity and destroy the
intrinsic motivation to perform it when no apparent reward apart from the activity itself is
expected’ (7–12). Although the case for the ‘hidden costs of rewards’ is certainly not indisputable, it does suggest that a
market in organs might reduce altruistic donation and overall supply . Perhaps the most celebrated
analysis of the tension between intrinsic and extrinsic incentives is Titmuss’ work in blood donation. His book, The Gift Relationship
(1971), argued that the ‘commercialization of blood represses the expression of altruism (and) erodes the sense of community’.
Payment undermined the altruistic motivations of would-be blood donors. Titmuss supported his
hypothesis by comparing blood donation in the United States and the United Kingdom. Analyzing data from England and
Wales over the period 1946–1968, where the sale of blood was prohibited, Titmuss found that the
percentage of the population who donated blood and the amount of blood donated steadily increased.
By comparison, in the United States, where the sale of blood was allowed, donations declined. Because
U.S. data were more fragmentary, Titmuss drew as best he could on a variety of sources, including surveys, municipal statistics and
comments by medical experts and blood bank officials. Nevertheless, he confidently concluded: The data, ‘when
analyzed in microscopic fashion, blood bank by blood bank area by area, city by city, state by state’, revealed ‘a
generally worsening situation’ (12). Following Titmuss’s lead, other studies have tried to buttress the empirical case for
crowding out. One intriguing experiment turned an Israeli day care center into a research site. It was not unusual for some parents
to arrive late to pick up their children; center administrators complained but levied no penalties. The researchers first took a baseline
measure of the frequency of lateness and then had the center post a notice on its bulletin board: ‘The official closing time. . . is
1600. Since some parents have been coming late, we. . . have decided to impose a fine. . .. NIS 10 ($2.50) will be charged every
time a child is collected after 1610. The fine will be calculated monthly, and is to be paid with the regular monthly payment’. Although
one might have predicted that late pickups would decline, the number actually increased. And even when several weeks later the
researchers had the center cancel the late charge, the higher level of lateness persisted. To explain these outcomes, the
researchers proposed that in the prefine days, parents interpreted the extra time that the teacher spent taking care of the children as
‘a generous, nonmarket activity’; they did their best to arrive on time because the teacher was considerate and should ‘not be taken
advantage of’. Once the fine was levied, the added time of child care had a price and parents believed they could purchase it as
often as necessary. ‘When help is offered for no compensation in a moment of need, accept it with restraint. When a service is
offered for a price, buy as much as you find convenient’. Moreover, the lateness persisted after the elimination of the charge
because there was no reverting to the older norm once the charge had been levied: ‘Once a commodity, always a commodity’ (10).
Another research team divided a group of teenagers who had been volunteering to collect contributions for disabled children into
three different cohorts: one was not paid for their service, the second was paid a small amount, and the third was paid a more
substantial amount. Using the total funds that each group collected as the outcome measure, they found that the best returns came
from the volunteers, the next best from the substantially paid, and the least from the lowest paid. Financial incentives, the
investigators concluded, proved less effective than moral commitments (13–15). Still others have highlighted the
potential conflict between extrinsic and intrinsic rewards by framing the following question: You see an older man hauling two boxes
of bottles to the recycling center on a rainy afternoon. Knowing that the center does not reimburse for bottles, you admire his
commitment to environmental concerns. Now imagine that the recycling center reimburses at a nickel a bottle and you witness the
same scene. Might your admiration turn to pity and stigma replace esteem? Might you consider the older man to be very cheap or
poverty stricken because he is returning bottles? Indeed, would you yourself be more or less likely to recycle where you paid for the
items (11)? None of these exercises are without important methodological weaknesses. The Israeli day care center may not have
made the fine severe enough. Had the lateness penalty been $50 or $100, not $2.50, extrinsic incentives might have worked better.
By the same token, had the teenagers been very well paid for their services, the reimbursed groups might have outperformed the
volunteers. These points notwithstanding, the literature on the hidden cost of rewards raises the prospect of
a market crowding out donation. Rather than donate and run the risks of surgery and future complications, family and
friends might opt to purchase an organ; and if the market is as efficient as proponents claim, the purchased organ would be equally
sound. This outcome is precisely what anthropologists have found in developing countries where
organ sale is routine. In India, for example, recipients did not want to ask family members to donate
and family members preferred to purchase (16). The same dynamic might occur here were organ sale permitted. Moral
incentives are now very well established in federal and state laws and an ethos of altruism is
emphasized by transplant teams. A new federal act (2004) and some dozen states now allow reimbursement for donor travel,
lost wages and living expenses (17). But no one permits financial gain. Altering the rules by introducing financial
incentives might undermine the system, discourage donation, and reduce supply . To counter this
possibility, proponents might point to the sale of sperm and egg and argue that opening a market in these body parts did not bring
deleterious consequences. However, egg and sperm are not analogous to kidneys. For one, there was no tradition of altruism in
sperm collection. Common practice was for students, usually medical students, to give their sperm for nominal sums. Second,
clinics have not relied heavily on the altruism of family and friends for egg donation, perhaps because of reluctance among some
would-be recipients to have the biological mother so prominent a figure in the child’s life (18,19). Thus, the sale of egg and sperm
does not directly speak to the tension between extrinsic and intrinsic reward.
AND- Even a small backlash cancels out the gain
Prottas, 92 -- Brandeis University professor and Institute for Health Policy senior staff
[Jeffrey, Ph.D., "Buying Human Organs - Evidence that Money Doesn't Change Everything," Transplantation, June 1992, 53(6),
Ovid, acccessed 8-27-14]
However this
assumes that there would be no negative reaction to offering to pay for organs. This is
very likely to be an erroneous assumption. Hostility to payment is strongest among those in the
population presently most willing to donate. Of those who express a willingness to donate, about 80%
reject any payment system. Among families that have actually do- nated, an even greater percentage reject the idea of
payment. If the percentage who would refuse to participate in a paid system approach these numbers, then a market system is a
even much smaller refusal rates would have a
marked impact. If 30% of present donors decide to opt out of the system, donation will drop by about
1200. This is, in effect, the breakeven point in terms of total supply. If payment induces the cooperation of 50% of
those now refusing to donate and causes 30% of the present givers to opt~out, then the supply of organs remains about
the same.
catastrophe. It would result in far fewer organs at far higher cost. But
Ext2—Crowdout (A2 “Sperm/Eggs Prove”)
Sperm/egg comparison is false- never had a basis in altruism
Rothman, 6 – Columbia University Public Health professor
[Sheila., and D.J., PhD from Columbia University, Assistant to the Deputy Director of the Center for the Study of Society and
Medicine at the Columbia College of Physicians & Surgeons at Columbia University, "The Hidden Cost of Organ Sale," American
Journal of Transplantation, 6(7), 2-13-06, www.societyandmedicine.columbia.edu/organs_challenge.shtml, accessed 8-27-14]
The same dynamic might occur here were organ sale permitted. Moral incentives are now very well established in federal and state
laws and an ethos of altruism is emphasized by transplant teams. A new federal act (2004) and some dozen states now allow
reimbursement for donor travel, lost wages and living expenses (17). But no one permits financial gain. Altering the rules by
introducing financial incentives might undermine the system, discourage donation, and reduce supply. To counter this possibility,
proponents might point to the sale of sperm and egg and argue that opening a market in these
body parts did not bring deleterious consequences. However, egg and sperm are not analogous to
kidneys. For one, there was no tradition of altruism in sperm collection. Common practice was for students,
usually medical students, to give their sperm for nominal sums. Second, clinics have not relied heavily on the altruism
of family and friends for egg donation, perhaps because of reluctance among some would-be recipients
to have the biological mother so prominent a figure in the child’s life (18,19). Thus, the sale of egg
and sperm does not directly speak to the tension between extrinsic and intrinsic reward .
Ext3—Status Quo Solves 2NC
3-D printing solves within 10 years—rapid advances
DAEF 14
An online platform launched by the Directorate General for Communications Networks, Content and Technology of the European
Commission to facilitate a broad reflection on future European policies, “Advances in bio-artificial and 3D-printed organs”
[http://ec.europa.eu/digital-agenda/futurium/en/content/advances-bio-artificial-and-3d-printed-organs] Accessed September 2, 2014
//
Organs such as kidneys, livers and lungs have always been in high demand by patients with severe illnesses. In
2008, 56 000 people were waiting for a suitable organ within the European Union. The demand exceeds the number of available
organs in Member States and is increasing faster than organ donation rates. Bio-artificial and 3D-printed organs
are critical for overcoming this challenge.¶ Advances in bio-artificial organs¶ Bio-artificial organs are the products of
tissue engineering. Scientists explain that tissue engineering uses the concepts and tools of biotechnology, molecular and cell
biology, material science and engineering to understand the structure-function relationships in mammalian tissues and to
develop biological substitutes for the repair or replacement of tissue or organ functions (Bioartificial Organs as Outcomes of
Tissue Engineering).¶ The generation of bio-artificial organs takes part in 3 steps:¶ Obtaining the patient’s autologous cells with
the help of biopsy procedure, isolating the cells from the tissue biopsy and increasing their number in the cell culture (outside
the human).¶ Transferring the cells onto a carrier structure (matrix) which is usually generated from animal tissue or from
synthetic components. In the lab cells sprout on the matrix, dissolve it and replace it by private proteins. ¶ After reaching a level
of maturation in the laboratory, the bio-artificial tissue is transplanted as replacement tissue into the patient. ¶ Dr Anthony Atala,
director of the Institute for Regenerative Medicine at the Wake Forest Baptist Medical Center in North Carolina (US) breaks
tissue engineering into four levels of complexity:¶ Flat structures that are made up of just one type of cells are the simplest to
engineer. Skin is an example.¶ Tubes like blood vessels and urethras which have two types of cells and act as a conduit.¶
Hollow non-tubular organs like the bladder and the stomach. These have more complex structures and functions. ¶ Solid organs
like the kidney, hearth and liver are the most complex to engineer because they have many different cell types and also require
blood supply.¶ German researchers are already mass producing swatches of real human skin. As of
2009, the price per unit was 34 Euros. The skin produced by Fraunhofer-Gesellschaft is exactly like the skin on human bodies –
made up of different cell types whereas skin manufactured previously used to be one thin layer made up of only one type of
cell.¶ Between March 2004 and July 2007, the research team at Wake Forest University led by Dr Atala built
artificial urethras for five boys using the patients' own cells. Tests measuring urine flow and tube diameter confirmed that
the engineered tissue remained functional throughout the six-year follow-up period. Scientists say
that bio-artificial urethras can be used successfully in patients and could be an alternative to the current treatment, which has a
high failure rate.¶ Anthony Atala also reported the successful transplantation of laboratory-grown
urinary bladders into beagles in 1999. Less than 10 years later the same procedure was repeated in humans
suffering from end-stage bladder disease - functional bioartificial bladders were successfully implanted into
patients.¶ Growing solid organs in the lab is however is much more complex. Organs like kidneys, lungs or hearts requires
putting a number of different cell types into the right positions and simultaneously growing complete networks of blood vessels
to keep them alive. Although the task is indeed challenging, scientists continue to make advances – Doris Taylor created a
beating rat hearth at the Texas Heart Institute in Houston. At the University of Michigan David Humes created a cell-phone-size
artificial kidney that has passed tests on sheep.¶ Some scientists believe that implanting bio-artificial solid organs into humans is
achievable, other remain more sceptical.¶ Advances in 3D-printed organs¶ The bioprinting trend is being driven by
three factors - more sophisticated printers, refined CAD software and advances in regenerative
medicine. Scientists are becoming increasingly interested in the field – from 2008 to 2011, the number
of scientific papers referencing bioprinting almost tripled.¶ Bio 3D printers function in the same way as
traditional 3D printers – tissue is printed layer by layer. Once a layer of cells is laid down by the printer, a layer of hydrogel that
operates as a scaffold material follows and the process repeats. When the cells fuse, the hydrogel is removed to create material
made entirely of human cells. The material is then moved to a bioreactor where the tissue continues to grow into its final form.¶
3D printing has already been used to create personalised prosthetics, human bones and human tissue. For example,
LayerWise, a Belgian metal parts manufacturer successfully printed a jaw bone in 2012. The artificial jaw was implanted into a
83-year old patient. San Diego-based company Organovo successfully prints small pieces of blood vessel
or liver tissue. Although the mini-livers are half a millimetre deep and 4 millimetres across, they can perform most
functions of the real organ. The ultimate goal of Organovo is to create human-sized structures suitable for
transplantation.¶ Currently, the biggest challenge in 3D bioprinting is producing larger branched
networks of blood vessels to nourish complex organs. Stuart William, executive and scientific
director of the Cardiovascular Innovation Institute (US), suggests that scientists will be able to
print fully functional hearts from a patient’s own cells within 10 years. First steps have already
been made – in the first half of 2013 researchers printed and implanted a portion of a heart and blood
vessels in mice.¶ Given the progress to date, further advances in bioprinting might even enable bionic organs – body parts
that restore and extend human ability. Scientists at Princeton University have conducted experiments aiming to integrate
electronics into bioprinting. Earlier in 2013 they created an ear that receives a wide range of frequencies using a coiled antenna
printed with silver nanoparticles. The artificial ear can pick up frequencies beyond the range of normal human hearing. ¶ Bioartificial and 3D-printed organs can not only alleviate the shortage of donor organs. Artificially created
organs can also be used to test the impact of new drugs, thus eliminating the need to test new drugs on humans. 3D models of
organs could also be used for educational and research purposes.
Stem cells solve
Rojahn 14 Susan Young Rojahn on January 16, 2014
MIT Technology Review
http://www.technologyreview.com/news/522576/manufacturing-organs/
Manufacturing Organs
Researchers around the globe are finding new ways to create tissues for transplantation . “Over 25
years, the field has gone from fiction and fantasy to science and engineering,” says Vacanti [at
Massachusetts General Hospita]. There are many different approaches, from precise ink-jet printing of cell types into an
organized structure (see “Printed Eye Cells Could Help Treat Blindness”) to letting cells spontaneously self-organize into protoorgans (see “A Rudimentary Liver Is Grown from Stem Cells” and “Growing Eyeballs”).
HART’s current approach is to grow a patient’s stem cells on synthetic scaffolds. The four most recent
artificial trachea surgeries have been done with these lab-made scaffolds, says David Green, CEO of HART.
Growing a patient’s own cells on a scaffold provides a good environment for bone marrow stem
cells that can then develop into various cell types both in the incubator and after they are
implanted into a patient.
HART creates the scaffolds by spinning fibers about a hundredth of the width of a human hair into a tube that is made to fit each
patient. The result is a customized scaffold “that makes a mesh that’s the right size for the cells,” says Green. “They feel at home
there.”
Stem cells taken from a patient’s bone marrow are then “rained down over the top of the scaffold ,
much like a chicken in a rotisserie,” says Green. The cells grow on the scaffolds in a specialized rotating incubator for about two
days before they are transplanted. About five days after the transplant, new cell types appear on the organ, he says, including
important cells that line the inner surface and help move mucous from the lungs by coughing. Eventually, blood vessels grow into
the synthetic organ, says Green.
A2 PERV (Disease)
No PERV- MMR proves, empirics prove, expert opinion, drugs solve
Ferrara, 1 -- Medical and science writer / editor
[Adi, "Should xenotransplants from pigs raised at so-called organ farms be prohibited because such organs could transmit pig
viruses to patients—and perhaps into the general population forum," Science Clarified, Vol 2, www.scienceclarified.com/dispute/Vol2/Should-xenotransplants-from-pigs-raised-at-so-called-organ-farms-be-prohibited-because-such-organs-could-transmit-pig-virusesto-patients-and-perhaps-into-the-general-population.html, accessed 8-29-14]
Animals who routinely carry an infectious agent are called hosts for the agent (virus, bacteria, or parasite). Endogenous retroviruses
are viruses whose DNA (deoxyribonucleic acid) sequence is integrated into the host's DNA in each cell of the host. We as humans
carry our own endogenous viral sequences in our DNA. Because the viral sequence is integrated into the host's DNA, it is extremely
difficult, and often impossible, to eliminate the virus from the host. There is concern that by transmitting PERV to humans, especially
immunosuppressed individuals, the virus can become "hot" and cause infection. Or perhaps a PERV particle, or even an unknown
virus that has not yet been detected in pigs, might combine with some of the human endogenous viral DNA to form a new, possibly
infectious, virus. The concern is a valid one and should be investigated. This concern also makes a good case for strict follow-up of
xenotrans-plant patients and their families. But the PERV situation is not unique. The current MMR (measles,
mumps, rubella) vaccine, made with chicken cells, contains particles of an endogenous avian (bird)
retrovirus. Because the vaccine is a live one, there is a possibility of combination between the avian virus and the MMR
infectious particles. To date, no infections of any kind have been reported as a result of the MMR vaccine.
The chance of a recombination event between retrovirus particles is far less likely to occur between nonhomologous sequences (sequences that share little similarity to one another) such as pig and human
retroviruses. A study of 160 patients who were exposed to living pig tissues or organs for lengthy
periods showed no evidence of PERV infection, or infection with any other known pig viruses.
Patients in this study, many of whom were immunosup-pressed during their treatment periods, were followed for more than eight
years post-treatment. The study is not a guarantee that such infections have not or will not occur, especially in individuals who
receive heavy doses of immunosuppression drugs. Nonetheless, this study is an encouraging sign. Dr. Robin Weiss, a virologist
specializing in retroviruses, estimated in an interview for Frontline's Organ Farm that the chances of a human
PERV epidemic infection are remote. Other scientists support his view. In addition, Dr. Weiss noted that a
currently available anti-HIV (human immunodeficiency virus) drug has proven very effective against PERV.
In a worst-case scenario, scientists already have at least one drug that can fight PERV infection,
should one occur. Drs. Walter H. Günzburg and Brian Salmons, in a 2000 paper assessing the risk of viral infection in
xenotransplants, pointed out that safety techniques used in gene therapy today can be successfully
adapted to control a "hot" PERV in humans.
Zero risk- would have seen it already, would require improbable mutations,
monitoring and drugs solve
Beschorner, 12 -- Johns Hopkins University School of Medicine professor of medicine in the departments of pathology
and oncology
[William Edward, University of Nebraska Medical Center president, "Xenotransplantation Has Potential," Organ Donation, Ed. By
Laura Egendorf, Detroit: Greenhaven Press, 10-1-12, http://emedicine.medscape.com/article/1014080-overview#aw2aab6b5,
accessed 8-29-14]
The viral zoonotic agents can be divided into endogenous and exogenous viruses. The endogenous viruses are encoded within the genome and,
therefore, cannot be eliminated from the herd using conventional technology. In 1997, coculture of human and porcine cells led to porcine
endogenogenous retroviruses (PERV) appearing within the human cells. Speculation about PERV progressed to a concern that it could potentially
become a public health hazard. Despite
considerable research, no pathology has ever been observed related
to PERV. Indeed, although a major portion of the world’s population either consumes or prepares
pork, no known PERV-related disease has ever been described. In a retrospective study of patients transplanted or
transfused with viable pig tissue, no evidence of infection was observed. A few subjects had detectable PERV RNA, but it was consistent with RNA
from circulating pig cells. In humanized mouse models infused with porcine cells, a few mice were described in which the human cells were initially
thought to contain PERV. However, subsequent studies attributed this apparent infection to murine leukemia virus. The
risk of PERV
becoming a public health hazard is infinitesimal . PERV would need to undergo a series of
improbable transformations to make it both a pathogen and contagious. Many herds of pigs have been
described in which PERV is not passed to human cells in coculture. Some strains of pigs have very limited copies of PERV in their genome. The
risk is further reduced by the extensive monitoring of patients and cohorts required and by the sensitivity
of PERV to antiviral agents. The minimal potential risk of PERV is far outweighed by the potential medical value of xenotransplants and
should not be a barrier to xenotransplantation.
New strains are PERV free
Beschorner, 12 -- Johns Hopkins University School of Medicine professor of medicine in the departments of pathology
and oncology
[William Edward, University of Nebraska Medical Center president, "Xenotransplantation Has Potential," Organ Donation, Ed. By
Laura Egendorf, Detroit: Greenhaven Press, 10-1-12, galegroup, accessed 8-29-14]
In addition to the stringent requirements for monitoring recipients, companies were concerned about the liability of pursuing a
technology perceived to be a potential hazard to the public health. However, since PERV was initially described,
numerous studies have shown no evidence of PERV becoming contagious or being pathological.
Many strains fail to pass PERV to human cells in coculture. The molecular virology of PERV passage
is now understood
. Swine
strains have been produced that are free of the PERV-C that is needed for passage. Indeed,
in the near future, swine strains will likely be produced with no genomic PERV.
Ext5—No Shortage 2NC
[impact is linear- if lots of people die ]
Donation up now
Gabriel Danovitch 8, M.D., Prof of Clinical Medicine and Nephrology at UCLA, and Francis Delmonico, MD, Clinical Prof of
Surgery at Massachusetts General Hospital, “The prohibition of kidney sales and organ markets should remain,” Current Opinion in
Organ Transplantation Volume 13(4), August 2008, p 386–394
One of the arguments repeatedly made in favor of commercialized living donation is that the current
noncommercial system has stagnated and is impotent to address the organ donor shortage. We most certainly
share the legitimate concern for the suffering of those waiting for an organ; we are motivated by it. That concern in itself, however, does not represent an argument in favor of
It is no longer true that the
rates of deceased donor organ donation are static. In the U nited S tates, largely through the efforts of so-called ‘Organ
Donation Breakthrough Collaborative’, the 3-month average deceased kidney donation rate has risen approximately
30% since January 2001 , and these increases have largely reflected increases in recovery of kidneys from standard criteria donors [28]. Multiple
innovative endeavors to increase other sources of donor organs are available. These include living donor
exchange, intended candidate donation, desensitization protocols for positive cross-match–and blood group–incompatible pairs,
increased use of donors after circulatory determination of death, and increased use of extended-criteria
donor kidneys. The kidney transplant waiting list continues to grow but the number of candidates on that list who are
deemed ‘active’ and hence transplantable has been stable over the last several years (www.unos.org accessed 3
April 2008). It is not ‘pie in the sky’ to look forward to a reduction in the waiting list to acceptable levels
commercialization, because it is quite unclear that a commercial system would be effective and it could well be destructive.
if we continue to invest our best efforts, resources, and ingenuity. Progress is also being made in the development of an improved
allocation system for deceased donor kidneys that will better exploit the life prolonging benefit of the procedure [37•]. All of these new endeavors
expand and exploit the noncommercial and altruistic driving force of our success to date. They build on
what we know rather than endanger what we have achieved.¶ Conclusion¶ We do not doubt that those of our colleagues who
support the commercialization of organ sales abhor the venal exploitation of vulnerable populations as a source of organs. We argue, however, that organ sales and
markets, ‘ regulated’ or otherwise , will inevitably lead to the furtherance of such exploitation and in the process undermine the
considerable gains that have been made in noncommercial organ donation both from the living and the deceased. Our arguments
are based not principally on theoretical or abstract ethical grounds but on documented practical experience and lessons learned from other disciplines. The international
transplant community will be best served by investing in public trust and not undermining it.
Trafficking
Ext1—Status Quo Solves 2NC
Global norms against sales are solidifying now and it’s decreasing the black
market and transplant tourism – but it’s reversible if the US legalizes organ sales
Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern
California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES
TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25)
India was one of about fifty
countries that undertook to reform their practices following the approval of
WHO’s original Guiding Principles. These countries adopted laws in the early 1990s to institute the
anticommercial system recommended by WHO. Similarly, a number of countries—including several
that were centers for organ sales, such as Pakistan and the Philippines, and other countries, such as Israel, that had
sent large numbers of “transplant tourists” abroad to receive vended kidneys40—have adopted laws and regulations in the
past few years that aim to put the 2010 WHO Guiding Principles into effect. 41 These changes have been
strongly supported by other intergovernmental bodies such as the United Nations,42 the Council of Europe,43 and the UN Office on
Drugs and Crime,44 all of which have addressed the phenomena of organ trafficking45 and of people being trafficked for the
removal of the organs.46 Equally significant in driving ethical and legal reforms have been the advocacy efforts of leaders in
transplantation medicine. For example, the Transplantation Society (TTS) and the International Society of Nephrology organized a
global summit on organ trafficking and transplant tourism in Istanbul in late April 2008, where a statement of professional opposition
to organ markets, the Declaration of Istanbul, was adopted.47 The
Declaration of Istanbul has since been
endorsed by more than 120 medical organizations and governmental agencies.48 Realizing that the
declaration would not be selfimplementing, its creators formed the Declaration of Istanbul Custodian Group (DICG) in 2010 to
encourage adherence to its principles and proposals.49 The DICG and TTS have produced some notable results by calling on
government officials to adopt and enforce prohibitions, and by making clear to them the harm done to the standing of medical
professionals who work in locales where organ sales are widespread.50 Furthermore, the DICG’s direct interventions to change
professional practices have been even more successful.51 For instance, academic recognition has been withheld from physicians
who have carried out transplants with organs from executed prisoners by barring the physicians’ abstracts from inclusion in
international medical congresses.52 Many medical journals have announced that they expect adherence to the Declaration of
Istanbul by their authors, just as they have long insisted that research conducted with human beings must adhere to the Declaration
of Helsinki, first promulgated by the World Medical Association in 1964.53 In at least one instance, several articles were retracted
from an academic journal when it was discovered that the work discussed involved living donors who had been paid to supply a
kidney.54 C. Recent National Changes in Response to Global Norms Bringing about thoroughgoing changes in transplant practices
requires more than academic and professional sanctions; governments must also adopt and enforce bans on
organ purchases and transplant tourism. The latter has proven particularly difficult, not the least because of the builtin opposition of the people who have profited from catering to transplant tourists. Accordingly, the hard-won gains in this
regard that
have been achieved in the past five years are all the more remarkable . Some local
proponents of organ-trade prohibitions have successfully used global standards in their
transformative efforts. This is illustrated by the experiences of Pakistan where the Transplantation of Human Organs and
Tissues Ordinance was adopted by presidential decree in 2007 before becoming a parliamentary act in 2010.55 Before the
ordinance, an estimated 1500 patients from other countries—principally in the Middle East—as well as about 500 wealthy Pakistanis
received vended kidneys each year, mainly in private hospitals and clinics in Lahore and other Punjab cities.56 The efforts to bring
that practice to an end were lead by the professionals associated with the Sindh Institute of Urology and Transplantation (SIUT), a
medical center in Karachi that provides donation-driven kidney dialysis and transplantation to all patients without charge. SIUT
supplied the “moral entrepreneurs: groups and individuals in civil society who are committed to the elimination of trade they consider
harmful and repugnant,”57 who mobilized public opposition to commercial organ donation. They urged the government to adopt the
new law. Descriptions written by SIUT physicians of the socioeconomic realities of the organ trade58 and of the resulting hazards to
both donors and recipients59 led to critical reporting of the practice in newspapers and on television.60 The media coverage took
specific aim at the role of the government, whose failed poverty-alleviation programs left individuals no choice but to sell their
kidneys, and whose failure to enact a transplant law and later to enforce it allowed the organ trade to thrive. It was also noted that
reports of Pakistan’s “flourishing kidney market” had appeared in the international press,
tarnishing the country’s reputation.61 The owners of the private hospitals who profited greatly from transplant
commercialism and who had strong connections to high-level officials mounted fierce opposition to the transplant bill and sought to
water down its prohibitions on unrelated living donation.62 On the other side, SIUT’s founder and director, Professor Adib Rizvi,
used his strong connections with international medical groups, particularly his membership in the DICG, to counteract these
powerful opponents.63 Prominent transplant surgeons among the DICG leadership came to Pakistan to convince
government officials that organ sales were a matter of international concern and needed to be
curbed to rehabilitate the reputation of Pakistani physicians.64 As Professor Asif Esrat concludes, “For
government officials, the desire to conform to widely held international norms and redeem the
national reputation served as a motivation for action.”65 When the law was contested in a federal Shariat court as
an interference with the Islamic duty to save life, the existence of the international standards, as embodied in the WHO Guiding
Principles (which Pakistan had joined in endorsing at the World Health Assembly), weighed heavily enough that the court rejected
the challenge.66 When several transplant programs continued to carry out commercial transplants, including on patients from
abroad, Dr. Rizvi and his colleagues reported these violations to the authorities and prosecutions were brought against the surgeons
and hospitals that had attempted to profit by breaking the law.67 The current situation in the Philippines resembles that in Pakistan
in some ways but differs in significant respects. The country has been a well-known locale for organ purchases for the past several
decades; indeed, it was one of the first places where the anthropologists of Organs Watch, an independent research and medicalhuman-rights project at the University of California, Berkeley, began their examination of the “new body trade” in which “the
circulation of kidneys follows established routes of capital from South to North, from East to West, from poorer to more affluent
bodies, from black and brown bodies to white ones, and from female to male or from poor, low status men to more affluent men.”68
Although Internet sites have made the Philippines another important locus for the global organ trade, the initial pattern of using
vended kidneys there differed from what had occurred in Pakistan because the recipients were mainly wealthy Filipinos, not
foreigners. 358 of the 468 kidney transplants recorded in 2003 by the Renal Disease Control Program of the Department of Health
in the Philippines involved domestic patients (though the possibility of incomplete reporting by private hospitals cannot be totally
discounted).69 It was thus not surprising that elite groups at that time supported a proposal under consideration by the government
to institutionalize paid kidney donation as well as to formally accept transplantation for foreign patients.70 As appealing as this idea
may have seemed to someone viewing it “from a private hospital room in Quezon City,” it was much less so for human-rights
advocates trying to protect potential organ sellers in “a sewage-infested banguay (slum) in Manila.”71 These advocates used the
attention that the World Health Organization was bringing to the issue at that time to halt the movement toward legalizing
compensation. Over the following five years, international pressure on the government intensified, not only from intergovernmental
and medical bodies72 but from the Catholic hierarchy, particularly in light of press coverage about unscrupulous organ brokers
trolling in the slums for donors to meet the ever-increasing demand for kidneys coming from Manila’s transplant tourists.73 On April
30, 2008, a ministerial directive barred foreign recipients from getting kidneys from Filipino living donors.74 The next year, the InterAgency Council Against Trafficking followed the international trend and used the organ trafficking provisions of the Philippines’ AntiHuman Trafficking Law as the basis for supplemental regulations outlawing all organ purchases, as well as other means of
trafficking persons for organ removal, including the use of force, fraud, and taking advantage of vulnerability.75 The fragility of these
legal changes in the face of the determined opposition is indicated by the next swing of the Filipino organ-policy pendulum. When
Benigno Aquino III assumed office as President in June 2010, he nominated as secretary of health Dr. Enrique T. Ona, a transplant
surgeon who had previously expressed his opposition to the ban on organ sales.76 The nomination was held up, however, when
Ona announced his intention to allow organ donors to be compensated by a $3200 “gratuity package”77 and joined several
American regulated-market advocates in sponsoring an international forum on “Incentives for Donation” in Manila that November.78
He was confirmed as health minister, however, after providing assurances that he would not institute financial “gratuities,” but he did
sign the proposal for incentives that emerged from the international forum.79 In effect, the pendulum has swung back, as the
number of foreign transplant recipients, which had risen to 531 by 2007 before the ban, fell to two by 2011, even as a threefold
increase occurred in deceased-donor transplants for Filipinos.80 Movement in the opposite direction remains possible, however, as
organ purchases by wealthy Filipinos have not completely disappeared, with brokers helping potential kidney recipients persuade
review committees to allow as “emotionally related” donations what are in fact commercial transactions.81 Another variation on the
theme of transplant tourism has taken place in Colombia, which “was a major provider of deceased-donor organs for wealthy
foreigners” during the first decade of this century,82 mainly for liver transplantation.83 With strong international and regional
backing, local medical leaders succeeded in redirecting organs to recipients from Colombia and neighboring countries. The annual
rate of transplantation to foreigners, which stood at 200 in 2005 (16.5% of the national total), was reduced to 10 by 2011 (0.9% of
the total, down from 1.45% the prior year).84 The situation in Colombia is indicative of the progress that has
been made across Latin America with the adoption by the Ibero-American Council of a set of principles and objectives in
a regional parallel to the Declaration of Istanbul, the Document of Aguascalientes,85 which was encouraged through a strong
alliance with the Spanish transplant program. The Document of Aguascalientes has provided legal and ethical as well as technical
guidance for countries across that region as they have created or strengthened their own systems for organ donation, allocation,
and transplantation that seek the support of the public and medical professionals and that aim to meet the transplant needs of the
domestic population and achieve “self-sufficiency” nationally or through regional cooperation.86 Over the past five years,
the most impressive examples of countries that have responded to stronger global norms
regarding the opposite side of “self-sufficiency”— namely, not sending transplant tourists abroad as the
means to meet domestic demand for organs—are in the Middle East. Israel’s enactment in 2008 of legislation
halting insurance coverage for commercial transplants that violate local laws ended its reliance on Turkey, South Africa, China, and
the Philippines, among other countries, as sites where Israeli patients could go to obtain vended kidneys.87 The law also stimulated
the development of a robust system of deceased and living-related donation, which has been widely praised.88 A number of
Arab countries have taken steps—thus far less sweeping in scope or impact than the Israeli program but still effective—
to treat patients at home rather than sending them abroad . The evolution of policy in Qatar provides a vivid
example of the competing forces at work: expediency, selfinterest, generosity, and concern about adhering to international norms.
The local provider of transplant services, the Hamad Medical Corporation (HMC), has concluded that it needs to go beyond the
existing Qatari program for honoring donors if it is to achieve self-sufficiency in organ transplantation.89 Consequently, the HMC
increased outreach within the expatriate community in Qatar (more than 85% of residents) to ensure that they too have access to
transplantation services.90 Additionally, the HMC has substantially increased deceased donation by publicizing that “brain death” is
acceptable under Islam91 and by having prominent persons, such as members of the royal family, not only recognize the generosity
of living donors and the families of deceased donors but also enroll in the organ-donor registry.92 A central component of the new
Qatari program is the Doha Donation Accord,93 which was formulated in November 2009 with assistance from the leaders of the
DICG and the International Society for Organ Transplantation, and which came into effect in 2010 following approval by the
country’s Supreme Council of Health. The accord aimed to combat organ commercialism, to create a deceased-donor program in
which everyone—whether citizen or foreign worker—would participate as both a potential donor and potential recipient, and to
provide a path to self-sufficiency in organ transplantation.94 The original accord departed from practices elsewhere in the region by
not offering any financial payment to the families of donors,95 but several of its promises—in particular, that a their family member
would be offered a free airplane ticket to accompany the deceased’s body from Qatar “at the time of donation”—do not align with
Guiding Principle 5 of the WHO Guiding Principles, which states that “[c]ells, tissues and organs should only be donated freely,
without any monetary payment or other reward of monetary value.”96 To the accord’s framers, it would have been inconsistent with
cultural norms of reciprocal gift-giving not to provide something of value to those who agree to donate organs for transplantation. To
outsiders, however, such a provision seemed to exploit the vulnerable situation of the families of Qatar’s manual laborers and
domestic workers from India, Nepal, the Philippines, and other developing countries, who would otherwise find it difficult to repatriate
their loved one’s remains.97 At a meeting in Doha in April 2013, held to mark the fifth anniversary of the Declaration of Istanbul, the
leaders of the HMC transplant program acknowledged the remaining shortcomings in the Doha Donation Accord and pledged to
make revisions satisfactory to the DICG.98 In particular, they pledged to ensure that any benefits provided to donors’ families would
be offered to the families of all potential donors, irrespective of whether they agree to donate their deceased relative’s organs for
transplantation; further, [A] social welfare program at HMC, in association with Qatar charities, provides assistance where required
to patients and their families. This assists in securing longterm medical care, supply of medications, and financial support during
residency in Qatar and sometimes following the return home of expatriates. For example, following a formal socioeconomic
evaluation, social services provide support to eligible families of all patients who die within HMC hospitals, including families resident
abroad. [W]hile the team at the Organ Donation Centre may directly refer families of critically ill patients to welfare services for
assistance as part of their routine care, such referrals and provision of welfare benefits are unrelated to donation decisions—a point
that is made clear to families.99 The forces at play in the movement of Qatar toward a more self-sufficient program of organ
transplantation are the same as those that have operated in the other countries described. In the countries that have provided
transplants to large numbers of transplant tourists, the forces favoring payments to living donors have largely been controlled by
those who directly profit from this business. But in Qatar, as in other countries that have sent most of their potential kidney and liver
recipients abroad for transplantation, those who had supported transplant tourism shifted toward favoring payments to donors in
Qatar, because they do not believe a domestic transplant program can be built without such financial rewards.100 In a setting like
Qatar where the population is sharply divided in both socioeconomic and ethnic terms, as well as by residents’ degree of integration
in, and identification with, the country and its institutions, it is particularly easy to understand the view that those who are
disadvantaged and disenfranchised will only respond to a request for assistance—in the form of a life-saving organ—when it is
accompanied by an offer to improve their condition materially. Nevertheless, the forces on the other side have been
successful—as they have been in Pakistan and the Philippines—in finding ways of overcoming
the barriers to voluntary donation that do not link benefits to an agreement to donate.101 In all these
settings, the local medical and human rights advocates opposed to giving material rewards for
organ donation have been inspired by professional and intergovernmental statements of principle
and have derived strength from the medical leaders and WHO officials who have assisted them in
persuading their governments to align national laws and practices with international norms . IV
BENEFITS, COSTS, AND INTERCONNECTIONS National patterns of organ donation can be expected to be
less diverse in the future, thanks to changes of the sort detailed above, as countries move away from their former
roles as buyers or sellers in what has been called “the global traffic in human organs.”102 But progress
toward a world in which all countries where organ transplants are performed103 rely on deceased and living-related donors, rather
than paying living donors and the families of cadaver donors, has been halting, and
the outcome is far from assured . To
a large extent, the
changes that have occurred have been heavily influenced by the WHO Guiding Principles and the
rest on the consistent practice of noncommercial organ donation in
the United States , Canada, and Western Europe for more than four decades. The hands-on advocacy of WHO and DICG
Declaration of Istanbul, which, in turn,
leaders has conveyed this vision to the responsible authorities in countries that have previously relied on paid organ vendors, and it
has reinforced the efforts of local medical leaders to reform national laws and practices. But if systems that have so long
embodied the ideal of voluntary, altruistic solidarity as their basis for organ donation and that have thereby
to move to a “regulated market” with financial inducements for
progress achieved in countries that have only recently come into line with, or that have
been moving in the direction of, the WHO Guiding Principles and the Declaration of Istanbul would
reverse course in short order . The proponents of paying for organs in those countries— whether they
attained the highest rates of donation were
donation, the
be surgeons and brokers who stand to profit from transplant tourists or those who believe it is necessary to offer material
expressions of gratitude in order to build a functioning organ-transplant system104—would seize upon the change of
policy in the West and say, “Clearly, no principle is offended by the sale and purchase of organs, for
these enlightened countries allow it; and if these countries, which are rich and medically well equipped, find payment
necessary to generate an adequate supply of organs, how can we succeed in any way other than by following their example?”
Ext2—No Model 2NC
Social science proves no modeling- US signals are dismissed
Zenko, 13 -- Council on Foreign Relations Center for Preventive Action Douglas Dillon fellow,
[Micah, "The Signal and the Noise," Foreign Policy, 2-2-13, www.foreignpolicy.com/articles/2013/02/20/the_signal_and_the_noise,
accessed 6-12-13]
Later, Gen. Austin observed of cutting forces from the Middle East: "Once you reduce the presence in the region, you could very
well signal the wrong things to our adversaries." Sen. Kelly Ayotte echoed his observation, claiming that President Obama's plan to
withdraw 34,000 thousand U.S. troops from Afghanistan within one year "leaves us dangerously low on military personnel...it's going
to send a clear signal that America's commitment to Afghanistan is going wobbly." Similarly, during a separate House Armed
Services Committee hearing, Deputy Secretary of Defense Ashton Carter ominously warned of the possibility of sequestration:
"Perhaps most important, the world is watching. Our friends and allies are watching, potential foes -- all over the world." These
routine and unchallenged assertions highlight what is perhaps the most widely agreed-upon conventional
wisdom in U.S. foreign and national security policymaking: the inherent power of signaling. This
psychological capability rests on two core assumptions: All relevant international audiences can or
will accurately interpret the signals conveyed, and upon correctly comprehending this signal,
these audiences will act as intended by U.S. policymakers. Many policymakers and pundits fundamentally
believe that the Pentagon is an omni-directional radar that uniformly transmits signals via presidential declarations, defense
spending levels, visits with defense ministers, or troop deployments to receptive antennas. A bit of digging, however,
exposes cracks in the premises underlying signaling theories. There is a half-century of social
science research demonstrating the cultural and cognitive biases that make communication
difficult between two humans. Why would this be any different between two states, or between a state and
non-state actor? Unlike foreign policy signaling in the context of disputes or escalating crises -- of which there is an extensive body
of research into types and effectiveness -- policymakers' claims about signaling are merely made in a peacetime vacuum.
These signals are never articulated with a precision that could be tested or falsified, and thus policymakers
cannot be judged misleading or wrong. Paired with the faith in signaling is the assumption that
policymakers can read the minds of potential or actual friends and adversaries. During the cycle of
congressional hearings this spring, you can rest assured that elected representatives and expert witnesses will claim to know what
the Iranian supreme leader thinks, how "the Taliban" perceives White House pronouncements about Afghanistan, or how allies in
East Asia will react to sequestration. This self-assuredness is referred to as the illusion of transparency by psychologists, or how
"people overestimate others' ability to know them, and...also overestimate their ability to know others."
Policymakers also conceive of signaling as a one-way transmission: something that the United States does and others absorb. You
rarely read or hear critical thinking from U.S. policymakers about how to interpret the signals from others states. Moreover, since
U.S. officials correctly downplay the attention-seeking actions of adversaries -- such as Iran's near-weekly
pronouncement of inventing a new drone or missile -- wouldn't
it be safer to assume that the majority of U.S.
signals are similarly dismissed ? During my encounters with foreign officials, few take U.S.
government pronouncements seriously, and instead assume they are made to appease domestic audiences.
Ext3—No Reg Spillover 2NC
AND- Plan spurs global underground markets
Caplan, 14 – NYU bioethics division head and professor
[Arthur, Ph.D. in the history and philosophy of science from Columbia, Drs. William F and Virginia Connolly Mitty Professor and head
of the Division of Bioethics at New York University Langone Medical Center in New York City, "Reply to Cherry," Contemporary
Debates in Bioethics, google books, 70-71, accessed 8-18-14]
Even worse, many Annas will live in other nations who will emulate our decision to permit markets. Those
Annas will have even less potential for choice and will simply be coerced, bullied, threatened, or forced
into kidney sales. When a market opens in the United States, it also opens in far less lawful and far more
impoverished parts of the globe. Since our ability to combat trafficking for organs, sex, baby sales, and
indentured slave labor depends on the moral position that incentives in these domains are wrong, it is a
bitter price to pay to allow a few Annas in the US to sell what will be forced from many, many more
in other parts of the world.
Pricing effects ensure
Suddath and Altman, 9 – reporter for Bloomberg Businessweek with a degree from Columbia University’s Graduate
School of Journalism, and Washington correspondent for TIME (Claire and Alex, 7/27. “How Does Kidney-Trafficking Work?”
http://content.time.com/time/health/article/0,8599,1912880,00.html)
The organ market is largely made up of impoverished and desperate sellers, wealthy, ailing customers and predatory middlemen.
Most sales take place in developing countries, where a kidney can often be purchased for the
price of a high-end TV. In Iran — the only country in the world where organ sales are legal — a healthy
kidney retails for about $6,000. The going rate is less than half that amount in India , which has an
abundance of doctors capable of performing the procedure and destitute masses often unable to
raise cash any other way. In January 2008, police busted an organ racket outside New Delhi that allegedly conned or forced
poor laborers to relinquish their kidneys to wealthy clients. Investigators say the ring operated for years and included a doctor, Amit
Kumar, who would use scouts to spot potential marks. Another kidney ring flourished in South Africa from 2001 to 2003, and black
markets thrive in nations like China, Pakistan and the Philippines.
Impact calc
Util Good: Isaac—1NC
They are moral tunnel vision
Jeffrey Issac (professor of political science at Indiana University) 2002 Dissent, Spring, ebsco
As writers such as Niccolo Machiavelli, Max Weber, Reinhold Niebuhr, and Hannah Arendt have taught, an unyielding
concern with moral goodness undercuts political responsibility. The concern may be morally laudable, reflecting a
kind of personal integrity, but it suffers from three fatal flaws : (1) It fails to see that the purity of one’s
intention does not ensure the achievement of what one intends. Abjuring violence or refusing to make common
cause with morally compromised parties may seem like the right thing; but if such tactics entail impotence, then it is
hard to view them as serving any moral good beyond the clean conscience of their supporters; (2) it fails to
see that in a world of real violence and injustice, moral purity is not simply a form of powerlessness; it
is often a form of complicity in injustice. This is why, from the standpoint of politics—as opposed to religion—pacifism is
always a potentially immoral stand. In categorically repudiating violence, it refuses in principle to oppose certain violent injustices
with any effect; and (3) it fails to see that politics is as much about unintended consequences as it is
about intentions; it is the effects of action, rather than the motives of action, that is most significant .
Just as the alignment with “good” may engender impotence, it is often the pursuit of “good” that generates evil. This
is the lesson of communism in the twentieth century: it is not enough that one’s goals be sincere or idealistic; it is equally important,
always, to ask about the effects of pursuing these goals and to judge these effects in pragmatic and historically contextualized ways.
Moral absolutism inhibits this judgment. It alienates those who are not true believers. It promotes arrogance. And it
undermines political effectiveness.
1NR
Link TO Solvency
Link turns case- backlash dooms entire transplantation enterprise
Richards, 12 -- Oxford philosophy professor
[Janet Radcliffe Richards, Oxford Uehiro Centre for Practical Ethics distinguished research fellow, "Do Current Organ Transplant
Policies Restrict Potential Donors?" Huffington Post, 9-5-12, www.huffingtonpost.com/janet-radcliffe-richards/organ-transplantpolicies_b_1857978.html, accessed 8-18-14]
Many of us wish that the state could requisition the organs of the dead and use them to save the living, instead of allowing them to
be wasted by burial or burning. As yet, however, public opinion is nowhere near allowing any such thing . Rightly
or wrongly, we make much more fuss about the rights of the dead than the benefit of the living. When there are public
scandals about transplantation, these are never about the lives lost that could so easily have been saved,
but about organs said to have been improperly procured.¶ So what can the transplant community do? It is
desperate to get more life-saving organs, but it knows that
the whole project depends on public support . It
must not seem too rapacious in its organ hunt, in case potential donors see their own rights as
under threat, and donations fall even further. Instead, it tries to work by appeals to generosity and altruism. People must be
assured that their organs cannot be used without consent, even though many patients will die in consequence.
Incentives collapse the fragile trust organ transfers are built on
Kahn, 9 -- Ph.D., MPH, University of Minnesota Center for Bioethics director and professor
[Jeffrey, “Kidney Failure: The Anarchy Of Living Organ Donation,” Star Tribune, 9-30-2009, l/n, accessed 8-18-14]
Aside from the known failures of even regulated markets, there are two compelling moral objections to the sale of
organs. The first is exploitation -- that is, when one person takes advantage of the misfortune of another for his or her own
benefit. There are many people in the world who have few opportunities to improve their lives, and for whom $5,000 or $10,000
offers truly life-changing possibilities. But it is only because of existing social conditions that selling a kidney for what seems to be an
impossibly large sum becomes attractive. Organ donation has always relied on the altruism of donors and their loved ones, with the
hope that any risk for the patient is balanced by the benefit of the good deed. But most people have a price at which they might
ignore whatever qualms they have about donation and become willing sellers. That changes the relationship -- from giving a gift to
being paid enough to ignore the risk. A market allows this shift, and it is a change we should be loath to accept. Second, the sale of
organs gives an advantage to those with the means to pay for them. Although the current system of organ allocation has problems
in terms of shortages and waiting times, it is at least fair. Rich patients can't pay to jump to the front of the queue. But that is exactly
what happens in the case of black or even gray markets for organs: Those who can pay get organs first. We might accept
such a free market approach with other commodities -- the newest car or the latest electronic gadget -- but it is
much less defensible to allocate scarce lifesaving medical technology in the same way. While the
existing system of organ donation is far from perfect, it saves thousands of lives every year. It is a system built on a
fragile trust that took long years to develop and needs constant attention. It is a trust that cannot
withstand the prospect of classified ads and online auction sites for human organs, alongside antiques, art and
sporting goods. Unlike banks, a bankrupt system of organ sales would allow no bailout.
Transplantation depends on doctor-patient trust
Caplan, 14 – NYU bioethics division head and professor
[Arthur, Ph.D. in the history and philosophy of science from Columbia, Drs. William F and Virginia Connolly Mitty Professor and head
of the Division of Bioethics at New York University Langone Medical Center in New York City, "Reply to Cherry," Contemporary
Debates in Bioethics, google books, 70-71, accessed 8-18-14]
Medicine is a business, but it is also a profession: one that relies on trust. If commercial concerns are
seen as overwhelming the protection of patient interests, then medicine will no longer be able to
function. If doctors do useless tests on patients solely¶ to make money, then patients come to distrust recommendations for
tests. If doctors will remove your kidney, cornea, lobe of liver, or limbs solely so that you and they may turn a
buck, patients soon will come to completely distrust their doctors. Transplantation depends upon
trust-to obtain organs such as hearts¶ and lungs, people must believe their loved ones are truly dead
before removal. Trust in that the surgeon will not give you an inferior or infected organ just to get a
paycheck. Trust in that you cannot bribe your way to access to an organ ahead of those in greater¶ need.
There is nothing that will destroy trust more in transplant than showing that doctors are quite
willing to harm their patients-especially those who are poor or vulnerable solely and only for
money.
UQ – Trust High
Steady support for doctor-patient trust – broad trend
McCanne 10-24-14 (Don, MD, “Public Trust in Physicians — U.S. Medicine in International Perspective,”
http://pnhp.org/blog/2014/10/24/improving-trust-in-the-profession/)
One emerging question is what role the medical profession and its leaders will play in shaping future national health care policies
that affect decision making about patient care. Research suggests that for physicians to play a substantial role in such decision
making, there has to be a relatively high level of public trust in the profession’s views and leadership. But an examination of
U.S. public-opinion data over time and of recent comparative data on public trust in physicians as a group in 29
a note of caution about physicians’ potential role and influence with the
U.S. public. In a project supported by the Robert Wood Johnson Foundation and the National Institute of Mental Health, we
reviewed historical polling data on public trust in U.S. physicians and medical leaders from 1966
through 2014, as well as a 29-country survey conducted from March 2011 through April 2013 as part of the International Social
industrialized countries raises
Survey Programme (ISSP), a cross-national collaboration among universities and independent research institutions. In 1966, nearly
three fourths (73%) of Americans said they had great confidence in the leaders of the medical profession. In 2012, only 34%
in physicians’ integrity has remained high . More than two thirds
of the public (69%) rate the honesty and ethical standards of physicians as a group as “very
high” or “high” (Gallup 2013).
expressed this view. But simultaneously, trust
Trust high – numerous indicators – no perception of profit drive
Laudicina 10-9-14 (Paul, former chairman emeritus of A.T. Kearney and chairman of its Global Business Policy Council,
“Ebola: Global Leadership Lessons,” http://www.forbes.com/sites/paullaudicina/2014/10/09/ebola-global-leadership-lessons/)
*italics original
According to a recent Gallup poll, Americans trust nurses, pharmacists, and doctors more highly than
reporters, business executives, or certainly politicians. People trust professionals in “white coats”
because – fairly or not – they have established trust on three different fronts: capability, reliability, and authenticity.
Medical professionals establish their capability or competence by meeting objective academic and clinical standards to qualify in
their fields. A sense of medical professionals’ reliability may be based on personal experience – if they
have successfully protected us in the past, we are more likely to trust them. Our sense of their authenticity
goes directly to our perception of their motivation: if we believe that they act for the good of their
patients and the public rather than out of self-interest , then we are likely to trust them – as long as we believe
that they are also capable and reliable.
Recent polls confirm doctor-patient trust is high
Xie 12-23-14 (Julie, “Why Nurses Are the Most Trustworthy Profession in the US,”
http://www.boston.com/jobs/news/2014/12/23/why-nurses-are-the-most-trustworthy-professionthe/WyTs4WU2kQZ5RrQRROU3TP/story.html)
Every year Gallup
asks Americans to rate how honest and ethical they perceive common professions
to be. Nurses, doctors, and pharmacists rounded out the top three in 2014 — a year when the Ebola
outbreak affected many in the medical profession. Eighty percent of respondents chose “high” when asked to rate the honesty and
Sixty five percent said “high” when rating medical doctors
and pharmacists. On the other end of the scale, only 8 percent of Americans say car salespeople have high standards, and 7
ethical standards of nurses, over “average” or “low.”
percent think members of Congress do.
Trust in doctors is high but can’t be taken for granted
Riner, 14 – MD, emergency physician
[Myles, MedPage, 2-15-14, www.kevinmd.com/blog/2014/02/patients-lost-trust-doctors.html, accessed 8-24-14]
But didn’t
a Gallup poll recently reveal that trust in doctors moved to an all-time high of 70% over
the last ten years? That’s true. Perhaps all of this hand wringing I just went through is based on an incorrect assumption:
we still have the trust of our patients (especially compared to the public’s trust in lawyers, stockbrokers, and members
of Congress). Great. I hope this poll is accurate: but members of Congress are at the bottom of the poll at 7%, and yet they all
keep getting re-elected. Perhaps those polled were thinking “I love my doctor, but I’m not sure about those other guys.” Regardless,
I think it is incumbent on physicians to recognize they need to earn this trust, and not take it for
granted; to watchdog their profession and those who practice it; to monitor themselves and how
incentives impact their behavior and their care; to promote respect from the public and the media; and to guard against the
insidious intrusion of the business of medicine on the practice of medicine. As someone who advocates
actively for fair payment for physician services; I can assure you this is no easy task.
A2 Harding
Trust in doctors is dead---healthcare costs and self-interested perception
Anne Harding 14, Live Science, "Americans' Trust in Doctors Is Falling", October 22, www.livescience.com/48407-americanstrust-doctors-falling.html
Americans' trust in the medical profession has plummeted in recent years , and lags well behind public
attitudes toward doctors in many other countries, according to a new report.¶ That lack of trust comes from how
Americans' perceive doctors' motivations, said Robert Blendon, a professor of health policy and
political analysis at the Harvard School of Public Health in Boston and co-author of the new report. While physician leaders elsewhere in
the world often take public stands on key health and medical issues, Americans perceive the medical profession as
looking out for itself, not advocating for public health, he said.¶ Just 34 percent of U.S. adults polled in
2012 said they had "great confidence in the leaders of the medical profession," down from 76 percent in
1966, according to the report.¶ And a survey of people in 29 countries found the United States ranked 24th
in public trust of doctors. Just 58 percent of Americans surveyed said they "strongly agreed" or "agreed" with the statement that "doctors
in your country can be trusted," versus 83 percent of people who said the same in top-ranked Switzerland, and 79 percent in runner-up Denmark.¶
Only Chileans, Bulgarians, Russians and Poles were less trusting of the medical profession, according to the report, which is published in the Oct. 23
issue of the New England Journal of Medicine. [7 Absolutely Evil Medical Experiments]¶ For
the study, the researchers analyzed
dozens of opinion polls looking at the public's trust in doctors. The findings indicate that, these days,
Americans see physicians as just another interest group among many, Blendon said.¶ "What's driving [trust
levels] down is that physicians in the U.S., as groups and leaders, are not seen as broad public advocates for health and health care issues," Blendon
told Live Science. "In the U.S., they're seen more as a group concerned with their own professional problems and economic issues." ¶ Making
matters worse, he added, is that there are 20-plus major physician specialty groups out there, and
each makes its own policy statements.¶ Although U.S. physician groups could burnish their image
by banding together and taking stands on important issues, such as the need to bring down
health care costs, they've largely been absent from these discussions , Blendon said.
L: Frontline – 1NR
Specific link defense is irrelevant- public assumes the worst version of the aff
Kiser, 8 -- Minnesota Medicine associate editor
[Kim, "The Contrarian," Minnesota Medicine, April 2008, www.minnesotamedicine.com/Past-Issues/Past-Issues-2008/April2008/Face-to-Face-April-2008, accessed 8-17-14]
the controversial idea, in which the government would
require Congress to revisit the N ational O rgan T ransplant
Recently, more and more groups have been asking Matas to discuss
control the price and distribution of kidneys. A trial would
Act, which outlaws organ sales. The law was passed in 1984 in response to a proposal by Virginia physician Barry Jacobs
to create a brokerage that would buy kidneys from people in poor countries, sell them to those needing a transplant, and profit from
the deal. (“Exactly the kind of thing we don’t want to see,” Matas says.) Among the organizations to which Matas has spoken are the
American Society of Transplant Surgeons, the American Transplant Congress, the World Summit on Organ Donation, and the
President’s Council on Bioethics. Earlier this year, his speaking schedule took him to the annual scientific meeting of the Canadian
Society of Transplantation in Mont-Tremblant, Quebec, the National Kidney Foundation’s scientific meeting in Dallas, and the Cato
Institute in Washington, D.C. During those talks, Matas ignites outrage. When speaking before the Cato Institute,
members of the panel compared his idea with black-market organ sales in the Philippines, Pakistan, and India,
and even with child pornography. On a podcast of the talk, Matas’ voice climbs an octave as he tries to set them straight: “We
can’t throw these horror stories out and say this has anything to do with what’s being proposed! I’ve been listening to Manila, to
India, to Pakistan, this has got nothing to do with what we’re proposing! Child pornography has nothing to do with what we’re
proposing today! We’re proposing a solution to solve a terrible problem for patients—patients who are dying on the transplant list!”
Matas believes that the ethical issues need to be balanced—that concern about exploiting the individuals providing kidneys should
not override concern for patients in need. He believes that a regulated system that doesn’t take advantage of people could be
established, and he emphasizes that until there is a trial, there is no way of knowing whether his idea would work. Untangling
people were mixing arguments was what drew Matas into the debate in the first place. As he
listened to discussions about how to solve the kidney shortage, he noticed people confusing the
issues of paying for organs from deceased individuals, reimbursing living donors for their
expenses, taking organs from prisoners against their will, and compensating destitute people for
kidneys that may not be healthy. “They were putting their arguments into one big basket , and it
didn’t make sense,” he says.
Arguments The fact that
Organ sales collapse trust in medicine and physician prestige
Caplan, 7 -- NYU bioethics division head and professor
[Arthur, Ph.D. in the history and philosophy of science from Columbia, Drs. William F and Virginia Connolly Mitty Professor and head
of the Division of Bioethics at New York University Langone Medical Center in New York City, "Do No Harm: The Case Against Oran
Sales from Living Persons," Living Donor Transplantation, ed by Henkie Tan, 432-434, google books, accessed 8-27-14]
Medicine has long held that the core ethical norm of the profession is the principle "Do No Harm".
Taking organs from living persons is in direct violation of this moral norm. The only way in which
it seems morally defensible to remove an organ from someone is on the grounds that the donor
chooses to undergo the harm solely to help another and that there is sufficient medical benefit to
the recipient. The creation of a market puts medicine and nursing in the position of removing body
parts from persons solely to abet their interest in securing compensation for themselves. Is this a role that the health
professions can ethically countenance (26)? What would engaging in damaging surgery for hire do to public
trust in physicians? The goal of medicine is the alleviation of illness, disability, and suffering, not
finding ways to permit persons to make a profit for themselves by interventions that cause them possible
permanent and significant harm. In a market, even a regulated one, doctors still would be using their skills
to help people harm themselves for money-solely for the money. The distrust and loss of prestige
that would follow is a high price for medicine to pay to gamble that a market may secure more organs for those
in need (26). Even if it is possible to get past the facts that there are no data that existing markets in organs have done much to
increase the supply, that there is much exploitation associated with such markets, since choice would be mostly an illusion, and that
a market using living sources severely compromises the ethics of the medical profession, is there any real chance of shifting public
policy toward a market? WHAT HAPPENS WHEN LARGE GROUPS OF AMERICANS DROP OUT OF THE DECEASED-DONOR
POOL? Even if it is possible to get past the facts that there are no data that existing markets in organs have clone much to increase
the supply, that there is much exploitation associated with such markets, since choice would be mostly an illusion, and that a market
using living sources severely compromises the ethics of the medical profession, is there any real chance of shifting public policy
toward a market? No solvency- health care providers won’t implement What little data exist show that health-care providers are
opposed to markets (19). If they are not willing to support markets out of moral reservations, then markets simply will not be
effectively implemented. Even more important than a patent lack of enthusiasm for markets among those who would be expected to
serve them, major religions and cultural views in the developed world will not countenance a market in
living body parts (20-22), Various Popes, for example, have made quite clear the Catholic Church's
aversion to markets in organs. Anglo-American law, ever since the days in which markets in body parts resulted in
graveyards being stripped to supply medical schools with teaching materials, has not recognized any property interest in the human
body and its organs (22). Alienating religions and cultures which do not view the body as property would have a devastating impact
on the supply of organs available. Indeed, some sub-populations in the United States, particularly AfricanAmericans, are as likely to
be turned off by the institution of a market in body parts because of their historical experiences with slavery and a keen distrust of
medicine, as they are to be motivated to become sellers to the rich (23-26). The argument that increasing the supply of organs
through sales will be efficient and cost- effective is not persuasive. It will take real and expensive resources to try to regulate and
police a market in organs. Since markets, even regulated ones, would shift the supply of organs toward those who can afford to buy
them, those who cannot might well withdraw from participation in the deceased-donor organ system, thereby putting in peril any
overall increase in the pool of organs available to transplant. The case for kidney sales is not persuasive. Existing experience with
markets has been dismal. The notion that free choice supports the creation of markets in human body parts does not square with
The devastating moral cost to medicine of
engaging in organ-brokering is far too great a price to pay for the meager benefit in supply that might be had by
the reality of what leads people to be likely to want to sell them.
those in need of transplants. The storm of opposi- tion that markets will trigger in many individuals based on religious or cultural
objections may actually produce a decrease rather than an increase in the overall pool of transplantable organs- an outcome that by
itself would make calls for the creation of markets dubious.
Organ sales crush trust in medicine- backlash against commodification,
inevitable screening failures
Budiani, 9 -- PhD, Coalition for Organ-Failure Solutions executive director
[Debra Budiani-Saberi, medical anthropologist, and Deborah M. Golden, sits on the Board of Directors of COFS, staff attorney at the
Washington Lawyers‘ Committee for Civil Rights and Urban Affairs, "Advancing Organ Donation Without Commercialization:
Maintaining the Integrity of the National Organ Transplant Act," June 2009,
https://www.acslaw.org/sites/default/files/Budiani%20Saberi%20and%20Golden%20Issue%20Brief.pdf, accessed 8-18-14]
Material incentives for organ donation have been tested in many countries, both in ¶ regulated and unregulated, or ―black,‖ organ
markets. These organ markets consistently lead to ¶ violations of human rights, and present ethical, social, strategic and economic
problems. ¶ Material incentives inevitably take unfair advantage of the poor and vulnerable who would ¶ otherwise not consider
resorting to a commercial living organ donation. Employing material inducement to procure organs from a certain
may also damage society's trust in medicine and transplantation and
simultaneously undermine efforts to secure and enhance altruistic donation. International opposition to commercial
segment of a population
donation has emerged as a response to the negative experiences of many organ donors who have sold their organs. The proposal to lift the ban on the sale of organs in the United States and permit Americans to
sell their organs would undermine international efforts to end such practices. Moreover, any deviation from this commitment in the United States also would have disastrous effects abroad, likely inducing more
countries to open legal and possibly unregulated markets of their own. NOTA and its prohibition on commercial organ donation should be preserved and proposals to open an American market should not be
pursued. There is significant potential in alternative methods to enhance altruistic and deceased donation that should be advanced without allowing the sale of organs in the United States. Part II of this Issue Brief
will review the history of the National Organ Transplant Act of 1984, which banned organ purchasing and sales. We will also discuss the movement to allow material incentives in exchange for donated organs
from both deceased and live donors, which has culminated in draft bills by the co-sponsors of the OTPA. This section will review the OTPA as it has been circulated. Part III will outline the problems associated
with material incentives for organ donation. This section will review lessons learned from countries that operate various kinds of markets for organ donation and present international responses to such markets.
Finally, Part IV will present the many available alternatives to allowing material incentives for organ donation. Many of these options have the potential to increase organ donations beyond anticipated gains from
the provision of material incentives. II. NOTA and Proposed Legislation A. The National Organ Transplant Act of 1984 The U.S. Congress passed NOTA in 1984 as the first attempt to regulate the growing practice
of organ donation and transplantation in the country.10 Until the discovery of cyclosporine, an anti-rejection drug, and its FDA approval in the early 1980s, widespread organ transplants between individuals not
closely related were not possible. The issue of material incentives rose to national prominence at the time because the first organ market was opening in the United States.11 Dr. H. Barry Jacobs, a private doctor
in Virginia, planned to pay donors their asking price for a kidney, add a few thousand dollars to the price for a profit, and sell the kidneys to recipients or to Medicaid and Medicare programs.12 At that time, there
were no legal prohibitions that would have prevented this doctor from implementing such a scheme.13 Reports of possible payment created a deluge of desperate offers from potential donors with no other hope
of financial support.14 Robert Steinberg offered his kidney for $25,000 to the University of Wisconsin-Madison Hospital and Clinics. He also offered to sell his left eye. He said ―Financially, I am in an awful
mess… I don‘t want to be on welfare.‖15 Bob Reina placed a classified ad to sell his kidney for $12,000.16 Steve Pollock had mortgaged his business and with no way to get a loan from a bank, took out an ad to
sell a kidney for $25,000.17 David Severn, faced with mounting debts and a house that would not sell in a down market, offered to sell a kidney, eye, or part of any other organ to raise $5,000.18 Joseph Greco
placed a similar ad after he had to sell his refrigerator for money and was keeping his food in an ice chest.19 He was willing to simply trade his kidney for a job.20 These reports illuminated the economic
desperation that drives people to an organ market. Then, as now, these stories evoked disgust and
sadness at the idea that people were driven to such extremes in order to survive. Public opinion
quickly coalesced around the idea of banning such commodification . Dr. Ira Greifer, medical director of the National Kidney
Foundation, derided the idea of the poor selling their organs as ―supply-side cannibalism.‖21 Lawmakers moved to pass NOTA in order to prohibit a market in body parts. Rep. Henry Waxman explained that ―it
is ethically offensive to look at organs and body parts the same way as we look at fenders from automobiles in the junkyard.‖22 Ultimately, lawmakers passed NOTA, section 301 of which prohibits the acquisition,
sale or transfer of any human organ for transplantation for ―valuable consideration,‖ upon penalty of up to a fine of $50,000 and five years imprisonment. 23 B. The Movement for Material Consideration for
Organ Donation Demand for organs remains high and unfulfilled. Various transplant professionals, academics, and attorneys in the United States24 and abroad25 argue that a regulated market in human organs
would reduce the patient waiting list for organs and in turn work to ameliorate the global illicit market and conditions of poverty for organ vendors. In the United States, proponents of a regulated market have
gained support from influential think tanks that favor market-based approaches such as the American Enterprise Institute for Public Policy Research26 and the Cato Institute.27 Proposals by market proponents
have included financial payouts or non-monetary benefits in exchange, or as a ―reward,‖ for an organ. The most commonly mentioned incentive is a tax deduction or a tax credit.28 Either of these is in essence a
government pay-out. Another proposed financial incentive is college tuition credits.29 Incentives that are not inherently fungible yet still valuable include job benefits,30 the shortening of prison sentences, or the
commutation of a death sentence to one of life in prison.31 Senator Specter has circulated at least five drafts of a proposed bill, now entitled the Organ Trafficking Prohibition Act of 2009 ( OTPA).32 The OTPA is
an undertaking by proponents of material incentives to amend NOTA such that a government entity would be permitted to provide compensation for an organ donation. The most recent version available as of this
writing states: The Federal and State constitutions empower the governments to provide a benefit to individuals who donated the gift of life to fellow citizens. The sovereign‘s provision of a gratuitous benefit to
organ donors is not commercial in nature and does not constitute a commercial sales transaction. This current draft also curiously cites the example of Israeli policy and states: Israel enacted a law that (A) makes
it a crime to buy, sell, or broker the sale of an organ irrespective of whether the prohibited act is committed within the nation‘s territorial jurisdiction and (B) provides gratuitous government benefits (i.e.,
comprehensive health insurance for life, free admission to national parks, and burial benefits) to organ donors. 33 The OTPA proceeds to list potential government benefits that could be granted to organ donors in
the U.S. including: medals, those benefits provided to veterans, tax credits and deductions, discounts or waivers of drivers‘ license fees, life insurance, disability and survivor benefits, a modest donation to a
donor‘s chosen charity, preference on the transplant waiting list, and tax credits for employers who pay lost wages. To implement the proposed policy change, the bill would exempt all ―actions taken by the
Government of the Unites States or any state, territory, tribe, or local government to the United States to encourage organ donation‖ from NOTA‘s prohibition on organ trafficking, selling, and purchasing. 34 To be
clear, this bill is not meant simply to allow small tokens of appreciation to be provided by the government. Rather, the OTPA aims to legalize government compensation of substantial financial benefits otherwise
out of reach for most Americans, especially in financially perilous times. Under this proposed bill, any imaginable compensation provided by any level of government would be legal—there are no proposed limits.
The government could conceivably compensate organ donors with anything ranging from citizenship, to commutation of penal sentences, to financial benefits. The proposed financial benefits listed in a previous
draft, such as funeral costs, college tuition waivers and health insurance, are not paltry sums. A funeral and burial can cost families $10,000.35 College tuition is another ever-rising cost. Currently, the average
public university has a yearly tuition of $6,585.36 Approximately 17% of Americans, 45 million people, are without health insurance."• Without other govemment assistance to pay for healthcare or education,
inducements of these levels may be irresistible for many people. Such incentive structures result in a variety of consequences-most of which are negative. It is of particular concem that the bill's main intent of
enabling the state to provide compensation or "rewards"• for an organ donation has been increasingly deemphasized in each progressive draft. Each draft has instead worked to highlight the more agreeable
terms of prohibiting organ trafficking while setting the aim to permit state provided material incentives and rewards to the background. For example, the initial draii of this bill was a three-page doclunent that mainly
discussed the concept of "valuable consideration"• and govemment incentives and only mentioned a fme increase for violations of NOTA. The current draft, however, emphasizes that there has been a
proliferation of organ trafficking and that there should be further prohibitions. It then proceeds to suggest that "ambiguous language in section 30l"• of NOTA had become "an unintended impediment"• for
fmancial incentives. The change of titles from "Organ Donation Clarification Act of 2008" to "Organ Donation Clarification and Antitrafficking Act of 2008"• and finally to "Organ Trafficking Prohibition Act of 2009"•
demonstrates the efTort to draw attention away from this central objective of the bill and towards the prohibition of organ trafficking, an already existing central element of NOTA. III. Faults of Material Incentives
for Organ Donation A system based on f`mancial or material incentives for donation is inherently flawed. This premise is supported by evidence that demonstrates that organ markets are universally problematicboth in the world's only regulated market in Iran as well as in the black and grey markets that exist in many other countries. Markets not only exploit donors, but also fail to meet the demand for organs, and may
even hann organ recipients. First, material incentives necessarily target the poor by providing inducements for their "donation."• A material payment for an organ most appeals to those individuals with insufiicient
employment, health care, housin| or education. It may even be coercive in a situation where a compensated organ donation is the only altemative for a destitute individual or family. This was the case in the United
Second, material incentives would induce lessthan-healthy donors to come forward and thus do not secure the best health outcomes for either recipients or donors.
Payments for organ donations lure potential donors (and their profiting parties) to deny that they may have
been exposed to HIV/AIDS, hepatitis, or tuberculosis. While appropriate donor assessment protocols should always be in place
for a donor and recipient‘s well-being, screening diseases with incubation periods, such as HIV, cannot always
produce results with certainty. Positive health outcomes must rely on structures of trust that will
States before NOTA was enacted, with desperate people seeing organ- selling as their only altemative.
be hurt with the introduction of material incentives in exchange for organ donation .38 38 This
same concern underlay the House version of NOTA, which was based on testimony submitted by Robert M. Veatch,
a professor of medical ethics at Georgetown University. He was concerned that financial profiteers
have motives to hide relevant medical history. See Scherf, supra note 14. Third, such incentives are likely
to undermine altruistic living and deceased donation. Individuals will be less likely to request a donation from a
family member if there is an alternative. Further, society‘s perceptions about transplantation may be adversely
affected and individuals may be less willing to consent to an altruistic or deceased donation when a market
value is given for a commercial donation. Compensation for organ donation also works to undermine the goal of
gaining national self-sufficiency in organ supplies via altruistic and deceased donation, which is a necessary part of the prevention of
organ trafficking.39 This effect can be seen in countries such as Malaysia and Oman, where nationals seek organs commercially
abroad with relative ease without facing legal or social approbation at home. As a result, Malaysians and Omanis typically do not
rely on relatives or deceased donations domestically for organ donation.40 Nationals of Malaysia and Oman therefore have no
incentive to push their own governments or civil societies to increase altruistic donation. Thus, most transplants of patients from
these countries are commercial in nature.
[Matt note: footnote 38 included]
---EXT: Trust Link
Incentives for organs would be a major blow to medical professionals
Joralemon, 1 -- Smith College anthropology professor
[Donald, PhD, "Shifting ethics: debating the incentive question in organ transplantation," Journal of Medical Ethics, 2001,
jme.bmj.com/content/27/1/30.full#xref-ref-33-1, accessed 8-18-14]
Conclusion
The above discussion has reviewed ways that members of the transplantation profession and other interested parties seem to me to
have sought to bring about a change in the ethical discourse concerning compensation for organs. The care with which
advocates are proceeding shows they recognise that the public is not clamouring for a reversal of
the prohibition against financial incentives. In fact, their caution reveals their own suspicion that
significant opposition awaits. My view is that this suspicion is well founded. There are still many
indications, both in the United States and in other countries, that money and vital organs occupy distinct
moral universes for substantial numbers of health professionals and members of the public at large.41 I am among
those who believe that the
domains.
profession will suffer a serious setback if it attempts to bridge these
More
Laws against organ sales funnel billions to the medical industry
Boyer, 12 -- JD candidate J. Reuben Clark Law School, Brigham Young University
[J. Randall, "Gifts of the Heart ... and Other Tissues: Legalizing the Sale of Human Organs and Tissues," Brigham Young University
Law Review, 2012 B.Y.U.L. Rev. 313, 2012, l/n, accessed 7-31-14]
Imagine a scenario in which a young individual tragically dies, but in a way that preserves almost all of her
internal organs. n2 Further, imagine that after she is declared brain dead at the hospital, her family decides to donate her organs. n3
Despite this magnanimous decision which will save others' lives, the family must bear all expenses for the funeral and
other final expenses n4 because, under current law, the family is prohibited from receiving anything in
compensation for the donation. n5 Yet, at the same time, thousands of dollars are changing hands
between doctors, hospitals, medical transport companies, and insurance companies in
completely legal business transactions for these donated organs. n6¶ This scenario is actually not
imaginary at all, but is the established system of organ and tissue transfer under current law. Federal and
state laws prohibit the receipt of consideration for an organ donation. n7 However, to say that
organs are not being bought and sold is to ignore reality. n8 While most people are somewhat aware of black
market transactions in various human tissues - mostly internal organs - fewer are aware that a massive and legitimate
industry has been built around the trade of human remains. n9 The [*314] same federal and state laws that
prohibit donors from receiving compensation for their organs and tissues facilitate this industry by
providing recovery of costs to anyone who removes, stores, transports, processes, or transplants
the organ or tissue. n10 Understandably, these provisions are essential to facilitate organ donations as doctors, hospitals,
medical transportation companies, and tissue banks need to earn money to operate. However, given that the demand for organs
n11 and tissues n12 is greater than the supply, these same doctors, hospitals, and medical companies inflate
the costs of their "services" to capture the entire value of the organ. n13 Despite the billions of
dollars changing hands in transactions for human tissues and organs, n14 the donors themselves are
prohibited from receiving any compensation. n15
That’s key to biomedical research
Knowledge@Wharton, 6
[The Wharton School of the University of Pennsylvania's online business analysis journal, "The Billion-Dollar Body Parts Industry,"
8-9-2006, knowledge.wharton.upenn.edu/article/the-billion-dollar-body-parts-industry-medical-research-alongside-greed-andcorruption-2/, accessed 8-1-14]
Body parts are big business in the United States. Tissue, organs, tendons, bones, joints, limbs, hands, feet, torsos
and heads culled from the dead are the cornerstones of the lucrative and important business of advancing
scientific knowledge and improving medical technique. Body parts are a billion-dollar industry;
they underwrite both cutting-edge research and everyday medical procedures. Major corporations such as
Johnson & Johnson, Bristol-Myers Squibb, and Medtronic rely on human remains to guide them in developing
medical equipment. Researchers rely on them to hone surgical techniques and even to create cosmetics. Doctors
use them to replace heart valves, to treat burn victims, to replace bone, even to plump up lips and eliminate wrinkles.¶ Few people
think to ask where the material that sustains this enormous industry comes from . But journalist Annie
Cheney is a timely exception. In Body Brokers: Inside America’s Underground Trade in Human Remains (Broadway), Cheney
chronicles her quest to find out how human remains are procured, processed, marketed and used. What she discovers is a
complicated tale of booming business and lack of oversight; of limited supply and endless demand; of unscrupulous brokers and the
earnest donors, scientists and doctors they exploit; of unspeakable violations of the dead enabling marvelous
scientific advancements.¶ The government regulates the procurement of organs and transplantable
tissue, but it does not regulate human remains used for research and education. According to the 1968 Uniform Anatomical Gift Act,
Cheney notes, it is illegal to buy and sell the dead. But according to this same law, it’s legal to recuperate costs
involved in securing, transporting, storing and processing cadavers. “Costs,” Cheney notes, is an
enormously expansive, exploitable term. It can and does mean whatever suppliers and brokers want it to
mean.
UQ – Brink
Biotech funding is on the brink- all available funding is key to innovation
Marshall, 14 -- Ph.D. in Chemistry, former Vice President of Technology and Business Development for Bioscience at
Thermo Fisher Scientific
[Bill, "Encouraging Biotech Innovation," Life Sci VC, March 2014, lifescivc.com/2014/03/encouraging-biotech-innovation/, accessed
8-13-14]
A truism of the biotech business is that what we are trying to accomplish is incredibly challenging, burdened by necessary regulatory
oversight, and requires a very high proof of product safety and benefit. This coalescence of factors results in a product development
lifecycle that is very long and costly, directly affecting the attractiveness of investment in our industry.¶ I often fondly remember
overseeing the development of products in the life science research tools business where discovery to product launch could be
measured in months. As ethical pharmaceutical developers, the bench to bedside lifecycle will likely be more than a decade.
Funding these operations, particularly at the earliest stages of discovery has become more challenging in the
last five years. This was driven by the financial meltdown of 2008 and the consequential restriction
in the flow of capital into high risk endeavors. The resultant capital rationing provided a Darwinian
natural selection of the opportunities in early stage biotech. While funding is available, it’s just
harder to come by .¶ Given the probability of success for any early innovation in biotech and the fact
that objective measures of validation are necessary to assess the potential of any new technology, in my view
it is better to
fund more shots on goal. To that end, I’ve been an advocate for tax reform that could help to add to the pool of available
capital for early stage biotech innovation.
Threat Real – Frontline
Synthetic biology makes bioterror inevitable- creates means and motive
Rose, 14 -- PhD, recognized international biodefense expert
[Patrick, Center for Health & Homeland Security senior policy analyst & biosecurity expert, National Defense University lecturer, and
Adam Bernier, expert in counter-terrorism, "DIY Bioterrorism Part II: The proliferation of bioterrorism through synthetic biology,"
CBRNePortal, 2-24-14, www.cbrneportal.com/diy-bioterrorism-part-ii-the-proliferation-of-bioterrorism-through-synthetic-biology/,
accessed 8-16-14]
synthetic biology has made bio-engineering
accessible to the mainstream biological community. Non-state actors who wish to employ biological agents
for ill intent are sure to be aware of how tangible bio-weapons are becoming as applications of
synthetic biology become more affordable and the probability of success increases with each scientific breakthrough.
In Part I of this series, we examined how the advancement of
The willingness of non-state actors to engage in biological attacks is not a new concept; however, the past biological threat
environment has been subdued compared to that of conventional or even chemical terrorism. The frequency and deadliness of
biological attacks has, thankfully, been limited; much of which can be attributed to the technical complexity or apparent ineptitude of
the perpetrators developing biological weapons. Despite the infrequency and ineffectiveness of biological attacks in
the last four decades, the threat may be changing with the continued advancement of synthetic
biology applications. Coupled with the ease of info rmation sharing and a rapidly growing do-ityourself-biology (DIYbio) movement (discussed in Part I), the chances of not only , more attacks , but
potentially
more deadly ones will inevitably increase .¶
During the last half century terrorist organizations have consistently had an interest in using biological
weapons as a means of attacking their targets, but only few have actually made a weapon and used it. The attraction is that
terrorist activities with biological weapons are difficult to detect and even more difficult to attribute without a specific perpetrator
claiming responsibility. Since 1971 there have been more than 113,113 terrorist attacks globally and 33 of them have been
biological. The majority of bio-terrorism incidents recorded occurred during the year 2001 (17 of the 33); before 2001 there were 10
incidents and since 2001 there were 6 (not counting the most recent Ricin attacks). The lack of a discernable trend in use of bioterrorism does not negate the clear intent of extremist organizations to use biological weapons. In fact, the capacity to harness
biological weapons more effectively today only increases the risk that they will successfully be employed.¶
The landscape is
changing : previously the instances where biological attacks had the potential to do the most harm (e.g., Rajneeshees cult’s
Salmonella attacks in 1984, Aum Shinri Kyo’s Botulinum toxin, and Anthrax attacks in the early 90’s) included non-state actors with
access to large amounts of funding and scientists. Funding and a cadre of willing scientists does not guarantee success though.
The assertion was thus made that biological weapons are not only expensive, they require advanced
technical training to make and are even more difficult to effectively perpetrate acts of terrorism with. While it is
difficult to determine with certainty whether the expense and expertise needed to create biological weapons has acted as a major
deterrent for groups thinking of obtaining them, many experts would argue that the cost/expertise barrier makes the threat from
biological attacks extremely small. This assertion is supported by the evidence that the vast majority of attacks have taken place in
Western countries and was performed by Western citizens with advanced training in scientific research. ¶ In the past decade
the cost/expertise assertion has become less accurate. Despite the lack of biological attacks, there are a
number of very dangerous and motivated organizations that have or are actively pursuing biological
weapons. The largest and most outspoken organization has been the global Al Qaeda network, whose leaders have frequently
and passionately called for the development (or purchase) of Weapons of Mass Destruction (WMD). The principal message
from Al Qaeda Central and Al Qaeda in the Arabian Peninsula (AQAP) has included the call to use biological
WMDs to terrorize Western nations. Al Qaeda has had a particular focus on biological and nuclear weapons because of their
potential for greatest harm. Osama Bin Laden, Ayman al-Zawahiri and Anwar al-Awlaki have all called for attacks using biological
weapons, going so far as to say that Muslims everywhere should seek to kill Westerners wherever possible and that obtaining
WMDs is the responsibility of all Muslims. Before the US-led invasion of Afghanistan, Al Qaeda had spent significant funds on
building a bio-laboratory and had begun collecting scientists from around the world; however, the Afghanistan invasion and
subsequent global War on Terrorism is thought to have disrupted their capabilities and killed or captured many of their assets.
Despite the physical setbacks, this disruption does not appear to have changed the aggressive attitude
towards obtaining WMDs (e.g., more recently U.S. Intelligence has been concerned about AQAP
attempting to make Ricin).¶ The emergence of synthetic biology and DIYbio has increased the
likelihood that Al Qaeda will succeed in developing biological WMDs. The low cost and
significantly reduced level of necessary expertise may change how many non-state actors view
bio logical weapons as a worthwhile investment. This is not to say that suddenly anyone can
make a weapon or that it is easy. To the contrary making an effective biological weapon will still
be difficult, only much easier and cheaper than it has been in the past.¶ The rapid advancements
of synthetic bio logy could be a game changer , giving organizations currently pursuing
biological weapons more options, and encouraging other organizations to reconsider their worth.
Because the bar for attaining bio logical weapons has been lowered and is likely to continue to be
lowered as more advances in biological technology are made, it is important that the international community begin to formulate
policy that protects advances in science that acts to prevent the intentional misuse of synthetic biology. Disregard for this
consideration will be costly. A successful attack with a potent biological weapon, where no
pharmaceutical interventions might exist, will be deadly and the impact of such an attack will
reverberate around the globe because biological weapons are not bound by international borders.
Disease
That wrecks effective response to disease outbreak
Carly Ruderman 6, Primary Care Research Unit, Department of Family and Community Medicine, Sunnybrook Health
Sciences Centre, “On pandemics and the duty to care: whose duty? who cares?” BMC Medical Ethics 2006, 7:5,
http://www.biomedcentral.com/1472-6939/7/5
The ethical foundations of the duty to provide
care are grounded in several longstanding ethical principles. Foremost among these is the principle
of beneficience, which recognizes and defines the special moral obligation on the part of HCPs [Health Care
Professionals] to further the welfare of patients and to advance patients' well-being . In modern health care, it
Do health care professionals have special obligations during infectious disease outbreaks?
is commonly understood and generally accepted that the principle of beneficence constitutes a foundational principle of the patient-provider relationship [15]. For the HCP in
general, and for the physician in particular, there are a number of compelling reasons to provide care in the context of an infectious disease outbreak. Clark [12] has recently
outlined three such reasons: 1. The ability of physicians and health care professionals to provide care is greater than that of the public, thus increasing the obligation to provide
it is evident
that the expertise of HCPs is an integral and principal component of the response to a pandemic .
There is no other sector of society that can be legitimately expected to fulfil this role and to assume this level of risk. 2.
care Although self-care and self-protection, as well as the care and protection of friends and family members, are acknowledged in pandemic plans,
By freely choosing a profession devoted to care of the ill, health care professionals have assumed risk Arguably, HCPs have consented to greater than average risk by their
very choice of profession. While it may be granted that the risk of contracting an infectious disease was likely not a concern for a generation of prospective health care workers,
medical literature in the last 20 years has shown that infectious diseases remain
ubiquitous and problematic – notwithstanding overly-optimistic statements regarding the future threat of infectious diseases. It is therefore not
unreasonable to argue that HCPs were aware of the greater than average risks posed by their choice of profession. 3. The profession is legitimated
by social contract and therefore its members should be available in times of emergency In publiclyfunded health care systems, such as those found in many Western societies, there is a strong claim for a social contract
between the HCP and society. It is a reasonable and legitimate expectation by the public that HCPs will respond in an infectious disease emergency.
Society has granted and permits professions to be self-regulating on the understanding that such a response would occur.
any informed reading of the
The role of professional codes of ethics One of the characteristics of a self-regulating profession is the development of standards of practice, sometimes referred to as best
practice guidelines. These standards are articulated in professional codes of ethics, which are developed on the basis of the fundamental principles and values of the particular
profession, as is the case, for instance, with respect to the codes of ethics that were developed long ago in medicine and nursing. Indeed, the code of ethics has a long and
respected tradition in the health professions and today most, if not all, the various health and social care professions have codes of ethics in place to provide guidance to their
in the health care
professions, codes of ethics should be interpreted as guides for ethical reasoning and frameworks for
the treatment of individual patients, rather than as substitutes for such reasoning or as an absolute mandate [17]. At the same time, a code
that is too vague can render it ineffectual and irrelevant . In an era in which health care and technology are evolving at a rapid
pace, efforts are necessary to ensure that codes of ethics remain current, practical, and concordant with public expectations. An informative and comprehensible code of
ethics has numerous tangible benefits . Perhaps the greatest benefit would be to dispel confusion and
uncertainty for HCPs concerning their professional rights and responsibilities as regards the duty to
care . Of course, a detailed treatment of the issue in professional codes of ethics would also serve to increase awareness and comfort levels, perhaps resulting in increased
members. The code of ethics is sometimes referred to as an instrument of "soft law," owing to its non-legislative nature [16]. As such,
willingness to provide care in uncertain and risky conditions [18]. Additionally, codes guiding professional conduct may effectively serve as norms of standards recognizable and
codes of ethics also serve as potent forms of
symbolic communication to the public that is served by the professions. By making explicit the values that health care
professions represent, professional codes of ethics can reassure the public that the trust invested in the
professions is justified and legitimate , as is properly noted in the following excerpt from the College of Nurses of Ontario Practice Standard on
enforceable by law, acting as the foundation of legal obligations and decisions [16]. Finally,
Ethics:
Disease reinforces conditions that produce poverty and structural violence
Rees 15 (Anna, “Diseases and the Links to Poverty,” January, January, http://en.reset.org/knowledge/diseases-and-linkspoverty)
Diseases and the Links to Poverty Poverty
and disease are stuck in an ongoing, vicious relationship . One
goes a long way towards intensifying the other with studies demonstrating that infection rates of
certain diseases are highest in regions where poverty is rife. According to the World Bank, an estimated 1.2
billion live in extreme poverty (defined as those who live on less than 1,25 USD per day) worldwide. Running parallel to statistics
about global poverty are statistics about infectious diseases. Terms such as “neglected tropical diseases” and “infectious diseases
of poverty” are employed to define a number of infectious diseases more commonly found in areas where poverty is high. This list
includes widely recognised diseases such as HIV/AIDS, malaria and tuberculosis as well as lesser-known ailments such as dengue,
chagas disease and foodborne trematode infections. The relationship between poverty and diseases is
emphatically intertwined however we paint with too broad a brush when we generalise that infection rates go down as
poverty declines. This trend is not a given and spikes in infection rates do occur when disastrous events take place such as natural
disasters or the outbreak of conflict. The Chicken and the Egg A common train of thought is that poverty is a driving force behind
poor health and disease. While certainly not disputable, that fact reflects only one side of the argument and does not take into
account the nuanced links between poverty and health. The fact of the matter is that the relationship between poverty
and health is inextricably linked , presenting a chicken-an-egg situation where one seemingly exists, in part, because of
the other. The Global Report for Research on Infectious Diseases of Poverty (put together by the European Commission, the World
Health Organization and TDR) offers a clear rationale of this relationship “Poverty creates conditions that favour the spread of
infectious diseases and prevents affected populations from obtaining adequate access to prevention and care. Ultimately, these
diseases...disproportionately affect people living in poor or marginalised communities. Social,
economic and biological factors interact to drive a vicious cycle of poverty and disease from
which, for many people, there is no escape .“ In short, poverty is instrumental in cultivating conditions that allow
disease to spread. In turn, infectious diseases exacerbate certain factors that contribute to poverty. In
many parts of the world, healthcare is not free nor is it cheap, placing huge financial stress on families who may already live under
the poverty line. Potential job losses and/or time off work due to illness or injury add to monetary burdens and have an adverse
affect on economic development while children who lose their parents to infectious diseases face an increased risk of being
exploited.
IL: Trust Key
Trust key to public funds
Rowe, 6 -- MRC HSRC, University of Bristol Department of Social Medicine
[Rosemary, former University of Bristol School for Policy Studies postgraduate researcher, "Trust relations in health care—the new
agenda," Eur J Public Health 16(1), Feb 2006, eurpub.oxfordjournals.org/content/16/1/4.full, accessed 8-18-14]
We would argue that trust is still essential to health care encounters, even if patients today no longer rely
exclusively on their ‘family doctor’ as an entry point to care. Trust encourages use of services, facilitates
disclosure of important medical information and has an indirect influence on health outcomes
through patient satisfaction, adherence and continuity of provider .5 Although trust is highly correlated with
patient satisfaction6 it is conceptually distinct. Trust is forward looking and reflects a commitment to an
ongoing relationship whereas satisfaction tends to be based on past experience and refers to assessment of performance.
As an indicator of future behaviour high levels of institutional trust are still very important . Now that patients are
able to participate in decisions as to where, when and how they are treated poses considerable challenges for health systems.
Those systems which have used GP gatekeepers to control referrals to specialist care in order to contain costs may find that they
can no longer do so in the light of patients' preferences for a particular hospital or consultant. Efforts to restrict patient choice are
likely to be strongly resisted as witnessed by the failure of the médecin référent scheme in France which sought to reduce choice of
physician. However, trust may offer a solution to these problems by limiting patients' desire to shop around or seek a second or third
opinion as it engenders loyalty. Institutional trust is also important to organizations in promoting efficiency, team
working and job satisfaction and may bring benefits to health systems as a source of social capital,
reducing transaction costs due to lower monitoring and surveillance and the general enhancement
of efficiency.7 It may also offer political capital in sustaining support for publicly funded services.
However, whilst public and patient trust is still important it can no longer be taken for granted . We would
suggest that new forms of trust relations are emerging now, in which trust has to be actively negotiated and nurtured.