Friday, 31 July 2009

I Have Two Kidneys, Right?

I mentioned yesterday that there were two Drum posts I was interested in discussing, this is the second.

The debate around legalising the organ market is one of those for which I've never come down on one side or the other, but it's sort of been simmering around in the back of my mind for a while now, so this seems as good a time as any to get something down about it. The basic argument seems to be between "exploitation" versus "people dying". On this level, I am far more persuaded by Somin than I am by Drum (who is also undecided on the issue, in fairness, though his current stance seems to be on the other side of mine, such as it is, to Somin's). A lot of people against the idea argue there is a point of principle here, but a principle has to be pretty damn compelling and clear before it's worth sacrificing up to 80,000 lives, and forcing up to 80,000 other people to be poorer than they need to be [1]. "Avoiding exploitation" is something I am entirely in favour of as a principle, but when compared to saving lives you need to be much, much more specific about where the problem lies, [2] especially in situations in which the exploited have a genuine choice, albeit one in which neither option is in any way desirable.

In this one respect, this debate has similarities with those over whether boxing should be banned, and whether prostitution should remain illegal. In both cases, those who argue for laws against the activity tend to point out that absent such laws people will be economically compelled to enter into them, despite the inherent risks, which is clearly A Bad Thing. The problem with this argument, though, is that if someone is economically compelled to get repeatedly punched in the face and/or sleep with strangers, preventing them from doing that must by definition have negative consequences on that person's life. If a woman has to choose between prostitution and starvation, then that's a horrible, horrible situation, but telling her she has to choose starvation is hardly helpful.

If this argument works for boxing and prostitution (and if anyone has any counters to it, I would be pleased to hear them), then it most certainly works in a situation in which someone else gets to live as part of the process. Certainly, if every time a boxer got knocked out a terminal illness was cured I'd be far more likely to watch Ricky Hatton do his thing.

On the other hand, I do see some validity in Drum's slippery slope argument (as he says, it's a terribly overused rhetorical trick, but it isn't entirely without worth). Here's the thing, though. Drum argues that if it's a kidney today, it's a cornea tomorrow. If it's a cornea tomorrow, it's a chunk of lung by Sunday. My question is this: why is a cornea worse than a kidney, or a piece of lung worse than either?

As far as I can see there are two options. Either body part X is no worse a thing to sell than body part Y, in which case Drum's argument doesn't apply, or body part X is worse, and therefore there is a concrete case to be made that we don't allow that part to be sold. I don't think either Drum or myself are in a position to sort those out from each other. Doctors would be, though, and hopefully legislators as well, assuming they bother listening to the experts. If it were done right, each individual body part would have risk assessments associated with them, and those risks would be clearly and thoroughly explained.

Following on from that, the two most compelling arguments against legalising the organ trade I can see are a) the risks involved are so complex and fiddly you couldn't reasonably expect the average person in the street to understand them, and b) the possibility that doctors will err on the side of collecting organs rather than ensuring donors are well briefed, and/or that the government will stack things in the favour of those requiring donations, since they have all the money. I'm not qualified to judge a) (though I don't find it tremendously difficult to credit as a possibility), and as far as b) goes, off the top of my head I would think the latter situation more likely (the occasional episode of House notwithstanding), but that's an argument against the specific wording of the legislation; I don't think it's strong enough on its own to justify a blanket ban.

Anyway, that's where I am right now. If anyone has anything to add, you know what to do.

PS: I should add that the title of this post comes from a conversation with Mad Richard, in which he told me his discovery that he had only one liver and two kidneys (rather than vice versa) had completely flummoxed his plan to drink like a teenager for his entire life, a revelation he likened to discovering Father Christmas wasn't real. Pointing out that the fictitious nature of Father Christmas was unlikely to have featured on the Y8 Science Syllabus back in school proved useless.

Update: Gooder suggests in comments that illegal fighting matches might be a more apt analogy than boxing, since the former is far more likely to be where anyone desperate enough to fight is going to end up. I've heard the argument used with explicit reference to boxing, but nonetheless I'm entirely happy to go with Gooder's suggestion instead.

[1] I freely admit that there is a problem with this formulation which is that once getting a kidney cut out becomes profitable, there will be far more people with only one kidney, which presumably will raise the number of people at risk of dying from kidney problems. The whole thing might descend into some bizarre game of musical chairs, only it's just the rich people who get to decide when the music stops.

[2] Drum is right to call this kind of formulation "baldly utilitarian", but then I'm a mathematician; I tend to be receptive to utilitarian arguments. Well, genuinely utilitarian arguments. One of the many reasons I distrust so many conservatives is their habit of choosing the course of action that maximises their utility, and then try to fudge some pseudo-explanation as to why that choice benefits everyone else (see also: "trickle down").

18 comments:

Senior Spielbergo said...

Gut Instinct – Selling of organs seems like a bad idea, and I think it’s the thought of exploitation etc that is what does it.

Slightly more thought out feeling – OK clearly having more people donate Kidneys results in more people living and that is obviously a good thing. Therefore logically anything that encourages people to donate such organs would on that basis be a good thing; however where I think it falls down is elsewhere. Specifically it is the fact that what this will basically boil down to is rich people who get ill will be able to pay poor people to give up their organs so they can continue their happy rich lives. A poor person who gets ill has no way of doing the same and therefore it lacks equity and potentially leads down the slippery slope argument of the rich tracking down organ matches and applying pressure to get them to donate.

I think what I would be OK with would be a government run financial incentive scheme, so as to encourage people to put themselves on the list and donate organs to whomever the neediest are. That way everyone is in the same boat and there isn’t any real possibility of someone exploiting the system, or someone gaining a massive benefit in terms of health care purely because they have a load of money.

My initial thoughts anyway.

SpaceSquid said...

I'm sympathetic to the argument that there wouldn't be equality, but that's already true for so many other things that I'm not sure it should disqualify this. It's another "we'd rather this situation doesn't exist" argument, which whilst understandable doesn't really get us anywhere. The rich already get access to better healthcare (or at least get similar healthcare quicker) over here (and the situation is much more unequal in the States), and whilst that bothers me, it does at least mean less patients for the NHS to deal with.

On the other hand, perhaps I'm misreading your argument. If you're suggesting the problem is that there is only a finite number of livers, and every one sold to the rich is one that can't be given to anyone else, then I see what you mean, and the NHS comparision above loses at least some of its relevance (you could argue that removing private medicine in this country would force the rich to fund the NHS through higher taxes, but that's another discussion).

The possibility the rich could pressure the poor into this sort of deal is a very good point. Whilst on that subject, though, if the government scheme you mention did exist, what's to stop the rich pressuring the poor to join that scheme instead? You couldn't be sure of getting an organ as quickly, but since you no longer need to use money to buy it, you can use your cash to put the screws on far more people, until eventually you get lucky. You could make such behaviour illegal, but that would be no more or less effective than making bullying illegal under the system Somin envisions.

Senior Spielbergo said...

It’s a moral question and I will fully admit that I typically tend to go with what my gut instinct says unless someone can come up with a really persuasive argument to the contrary, but I’m still thinking about the issue at this point, and trying to figure out if the advantages do outway the negatives.

I certainly think there is potential for various problems to emerge and the problems seem like they could come from various fronts:

I think you will have an issue whereby organs aren’t necessarily going to go to those people who need them most. Not in a lot of cases but clearly if you have a rich guy who can “skip the queue” and he doesn’t have an immediate need but can last some time while someone else does, it creates a problem if he can pay money to get that organ.

Likewise you may well get people acquiring organs they don’t really need (so whereby treatment is not necessary to save their lives) and that of course denies someone who really does need it from possibly getting it.

I also on a personal level don’t like the feel of putting someone in a situation where selling one of their organs is a choice made out of financial necessity. While you make the point that having the option is better than just leaving them to starve, personally I would hope that in developed countries no one is actually going to be in the situation whereby that is the choice. Even the poorest people in America / UK have their basic needs taken care of by the State (you can argue how well that is done but the basic principle is that no one should do without food at the very least). Therefore what you are actually giving them is a choice for something not strictly speaking essential and donating an organ. It might seem important (maybe giving your kids a better education, maybe paying of the mortgage) but it shouldn’t ever be a life or death situation. That is a lot more woolly and I think you could have people being pressured into doing something they actually don’t want to do, purely for financial reasons and pressure may well come not just from the rich guy wanting the organ, but those people looking to benefit from your sudden influx of cash.

Pause said...

If organ donation was opt-out rather than opt-in, wouldn't that render this entire subject redundant? I'll be first to confess I don't know the numbers, but I assume there are a considerable number of suitable donors each year, if perhaps not enough to meet the current backlog of demand overnight.

It doesn't solve any money problems, and may only swap one set of ethical/moral complications for another, but it seems to me this latter set are considerably easier to resolve to the satisfaction of a majority (surveys usually showing over half/two-thirds of UK residents would be donors, despite less than a quarter being on the register).

Or failing that, making a concerted effort to send donor forms out to everyone when they hit e.g. 18. They get the TV licence warnings out quickly enough, after all...

Gooder said...

It is an interesting debate and to be honest I'm not sure exactly where I land. I suspect I'm on the side of caution here, there is jsut something about trade in organs that seems a bit wrong on a gut level.

One distinct issue I think is that as it stands it's the most vunerable who end up selling body parts and I don't think legalisation is likely to change this, as selling you organs will always be a measure of almost utter desperation.(Are being actually prosecuted for selling an organ?)

Those living on the bread line probably need all the lungs they've got!

On a side note I don't think boxing holds up in the analogy alongside prostitution. Ok, boxing may be the only viable way out for some people but it is a regualated, organsied sport and doesn't really work as last resort unless you have the talent to compete.

If you are thinking of illegal fights than I'd suggest that's fighting not boxing.

SpaceSquid said...

Don't talk to Spielbergo about "opt out organ donation", Pause; he doesn't wanna hear it.

"I also on a personal level don’t like the feel of putting someone in a situation where selling one of their organs is a choice made out of financial necessity."

I take the point that no-one is likely to literally starve (they might die of exposure, but if memory serves only those currently using drugs are denied shelter, and they're not likely to be the sort of people we'd want organs from in any case), but your argument seems hazy on the difference between "financial necessity" and "desirable but financially unreachable". If it is a necessity, than the above argument still holds (in the States, for example, you could easily concoct a situation in which someone has a terminal disease that leaves the kidneys unaffected, so selling one such organ is the only way to pay for the treatment that will save their life). If it is simply desirable, then I understand what you're driving at, but if that desire is stronger than the desire to retain both kidneys, it's still not clear what the advantage is in refusing to allow that exchange to be made.

Having said all that, the point that the problem might not be Lord Moneybags wanting a kidney so much as your daughter wanting a pony isn't something I'd ever considered. "If you really loved me, you'd have a scar and I'd have Mistress Sugalumps". It's actually a pretty good point.

Also, having ruminated on the NHS problem, it occurs to me that in situations where both private and NHS patients share the same machinery, or require medication that is in short supply, the same dynamic would kick in as would if all the rich people started buying kidneys.

SpaceSquid said...

It occurs to me that I also have a gut instinct that suggests organ selling is bad, but then I've learned not to trust my gut.

"On a side note I don't think boxing holds up in the analogy alongside prostitution. Ok, boxing may be the only viable way out for some people but it is a regualated, organsied sport and doesn't really work as last resort unless you have the talent to compete."

I'm not particularly wedded to the analogy, so if it doesn't persuade I'm cool with it, but since it's been brought up I'd argue you can argue boxing is not a particularly plausible way out, for the reasons you mention, but that doesn't mean everyone involved didn't start off for lack of any other option.

"If you are thinking of illegal fights than I'd suggest that's fighting not boxing."

I'm entirely happy with switching to that instead.

Tomsk said...

People: just because your gut instinct tells you something, doesn't necessarily mean you shouldn't listen.

The whole idea of a market in organs is a vicious moral sleight of hand.

If you truly believed in maximising the chances of people needing transplants, you'd make it compulsory for everyone, rich and poor, to donate spare organs as and when the need arose.

Wait, comes the response - from the comfortably well-off - wait! That's not fair! You can't force everyone to give away their body parts!

But isn't that exactly what you're doing when you present the "starvation or donation" argument to the poor person with surplus kidneys? If someone needs a financial incentive to donate, they are by definition having their lack of wealth exploited.

If you truly believed in helping poor people out of poverty, you'd give them more money, no strings attached.

The gut instinct of horror is your inbuilt sense of morality trying to tell you something: that to muddle the two issues together, like some kind of macabre tax credit, is immoral.

Tomsk said...

Also, Drum is spot on with his worry about the possibility of a global trade in organs. The moral issue is exactly the same, but on a global stage the exploitation becomes so much more obvious.

SpaceSquid said...

"If you truly believed in maximising the chances of people needing transplants, you'd make it compulsory for everyone, rich and poor, to donate spare organs as and when the need arose."

Surely you mean "If you truly believed in maximising the chances of people needing transplants over all other considerations". Whether there exists a moral compunction to donate an organ is a very different consideration to whether there exists a moral compunction to ensure that donations happen irrespective of the donors wishes. In other words, there is a scale between "I could do this" and "I must do this" that you have bypassed, and "I should do this" is somewhere along it.

"But isn't that exactly what you're doing when you present the "starvation or donation" argument to the poor person with surplus kidneys? If someone needs a financial incentive to donate, they are by definition having their lack of wealth exploited."

That, or they are having their desire for more wealth made use of. How is my agreeing to write maths in exchange for money not "exploitation" by your definition? If I had more money, I wouldn't do it. I do it because of the financial incentive. That isn't exploitation, it's being in a situation where a given transaction is desirable to both parties. The fact that it wouldn't be desirable to someone with more money doesn't make it exploitation.

The only diffence I can see is my downside to not working is almost certainly far less serious than theirs is for not donating. However, if I was told that quitting my job would lead to my death, I would be obviously massively angry (and scared), but once that reality is in place, telling my bosses that the best idea is to fire me (or, if you prefer, to not renew my contract when it expires) doesn't seem particularly wise.

"If you truly believed in helping poor people out of poverty, you'd give them more money, no strings attached."

If the argument here is that charity is a much better idea than offering cash for kidneys, then in theory I agree totally. But charity alone ain't getting the job done, is it? Giving your money to the poor without asking for the kidney you need to save your life is much more noble than the alternative, but it doesn't follow that the alternative itself is bad, or worthy of leglislating against.

As I say, I'm entirely in favour of charity. I wonder though whether telling the poor "You can have what scraps we're prepared to leave for you, but don't you dare try to sell us something we need because we don't think it's moral" is going to strike them as a particularly awesomeboots idea. It seems to me you're saying "Unless people want to help the poor entirely altruistically, we will ensure that it doesn't happen". Quite aside from wondering whether any act of charity is truly altruistic (not that I'd ever suggest a sense of self-worth is comparable to acquiring a new internal organ), it seems clear to me that helping the poor for no gain is better than helping them for some gain, which in turn is better than not helping them. Your argument seems to swap around the latter two cases.

"Also, Drum is spot on with his worry about the possibility of a global trade in organs. The moral issue is exactly the same, but on a global stage the exploitation becomes so much more obvious."

I sympathise entirely with the fears of global trade, but in my case this is because my fear that the specific set of rules put in place to govern the system would be much easier to abuse once the international market comes into play. That might be unavoidable irrespective of how much care goes into crafting the relevant legislation, of course.

Tomsk said...

"That, or they are having their desire for more wealth made use of. How is my agreeing to write maths in exchange for money not "exploitation" by your definition? If I had more money, I wouldn't do it. I do it because of the financial incentive. That isn't exploitation, it's being in a situation where a given transaction is desirable to both parties. The fact that it wouldn't be desirable to someone with more money doesn't make it exploitation."


This I think is the crux of the argument. If you accept the premise that selling a body part is equivalent to writing maths for money, then of course there is no moral objection to the economic transaction.

I don't accept that premise. Selling parts of your body is nothing like writing maths. It's a sacrifice. Of course a kidney is a soft target for wannabe organ-traders because we happen to have a spare, but removing it is nevertheless still a sacrifice in a way that writing maths is not. In essence: you can always write more maths. You can't grow another kidney. It's not like selling your dead toenail clippings.

Of course, we're in the happy situation where donation of a kidney is possible, at least if you have two in good order (spare a thought for the poor people who don't). But there should be no external pressure to make this decision, whether legal or financial. It should be between you and your own conscience.

If you don't accept the notion of sacrifice, consider the converse: what if your statement were true and kidney donation really was no bigger deal than writing maths. Then why not make it compulsory by law? I would certainly make writing an hour of maths before bedtime compulsory if it somehow directly saved the lives of people who were born without mathematical ability. After all, we all have to do it up to 16 years of age anyway. If we deny the difference between maths and kidneys, we must write this law. We could choose people by lottery, and give them financial compensation for their trouble. There could be scratchcards. It'd be fun! After all, there's no sacrifice involved, so it's everybody's duty to help out and save some lives, right? At least that would be fair.

Legal pressure is of course not the same as financial pressure, but I would argue that they are morally equivalent. You imply that a potential donor's wishes are not respected with the first but are with the second, but the relentless pressure of money contorts wishes as surely as any law. I'm trying to lure you into seeing how an external pressure would affect you and your rights to your own body, instead of the nebulous and ever put-upon poor.

Tomsk

PS: As for charity - well, I wasn't really talking about charity, I meant a generalised "you" as in the nation as a whole, i.e. the welfare state - but anyway, when you say that "charity alone ain't getting the job done", do you really think that organ trading will get the job done? Surely you will at least concede that there are much better ways of helping the poor than giving them money for their bodyparts. For example, they could sell their children as food.

SpaceSquid said...

That's a good argument, Tomsk, but I have a few problems with it, which I'll have to stretch over two comments. First of all, writing maths is a sacrifice. It would be sheer lunacy to argue it was within a million miles of the sacrifice of a kidney, but it still requires I give something up (in this case time, and the ability to not have stress headaches). That the maths itself is theoretically in infinite supply is not the issue.

The above point might seem not worth making, but it ties into the issue of relative costs. Drum is also right when he points out there is a difference between a single large cash sum and a longer period over which that money is doled out bit by bit, but leaving that aside your "maths law" analogy fails because it assumes using maths to save a life would be easy. If an hour of maths each day saved a life every four years, I'm not so sure the suggestion it should be made compulsory would go down so well. In working days you're talking about an eight month long job for each life saved. I'm not saying such a job wouldn't be worth it, just that I doubt you'd be willing to sign off on making such a thing compulsory even if it did just involve you sitting at a desk. (I admit I kinda pulled the four years out of my arse a bit, I assumed the cost of a kidney was about 100 000 quid, so the maths may need adjusting).

In fact, mathematicians are the wrong occupation to consider here. Consider the entirety of the kidney transplant procedure. You need a donor, you need a doctor to check the donated organ will be viable, a surgeon and his or her team to remove the organ, a courier to get a kidney from one place to another, then another surgery team to put it in, then various other doctors and nurses to deal with the post-op side. Every single one of those people has helped save a life. The donor is the only one who doesn't get paid to do it. By your argument, its because their sacrifice is too great to attach a value to it.

What if we changed the board, though? What if the surgeon herself had only a few, say, days to live? Some pernicious infection that left her entirely able to perform her job, but was coming ever closer to snuffing her life out. What do we argue here? Certainly losing an hour or two out of the few hundred that remain can be seen as a far greater sacrifice than a kidney, clocks tick in a way our bodies don't. Do we argue she is not allowed to perform the procedure? Or do we simply tell her she can go ahead, but in order to not feel financially pressured into it (she does, after all, have a large family about to lose their principal earner) that she is having her salary reduced to nothing effective immediately? If we assume that there is no reason to doubt her competency as a surgeon, do either of these positions seem particularly sensible?

SpaceSquid said...

Whilst I take the point that "relentless financial pressure" can essentially become as persuasive as law, I am far from convinced that makes them morally equivalent. I'm also less than enthused by the idea that the only reason I'm on the fence here is that I am assuming that only the "the nebulous and ever put-upon poor" would have to make such a choice, and that the root of my problem is some kind of lack of empathy that would go away if only I could put myself in their shoes.

My issue is very different, as has been pointed out several times and I'm still not sure has been dealt with particularly well. If you are in dire enough financial straits for the pressure to be so great as to be equivalent to a legal imperative, why is the best solution to ensure that pressure remains unchecked? By adding legal pressure? It is, of course, a terrible thing that someone might end up sitting between two such horrible choices (though different people will have different utilities for keeping a spare kidney), but arguing that legal and financial pressure can be equated wont help me understand why you are convinced the best way to deal with the situation is to automatically block one course of action.

On the topic of charity, I was in no way arguing selling kidneys is a cure. I was pointing out charity most definitely isn't a cure either, and setting aside all other issues for just a moment, two methods of alleviation are better than one.

Actually, though, it does occur to me that charitable donations might well go down should such a law be passed, since people could just sniff and argue "They should just sell a kidney". I don't have any idea how big the drop would be (it's not like there aren't dozens of other BS reasons not to give to charity), but it would certainly be one of my bigger worries about the whole thing.

Tomsk said...

I hear your pain regarding maths, but I think you're right to call an end to argument by maths analogy. I'll say only that I regard an organ donation as a different category of sacrifice to giving up one's time to maths, not just a difference in magnitude. And anyway, a moderate amount of maths is good for you, like all-bran for the brain.

The complaint that many people are involved in the transplant procedure and yet only the donor doesn't get compensated is a stronger one at first reading. Surely the donor should also get as much as the market will bear? But this argument blithely conflates the concept of time given by the workers with the kidney given by the donor. There are two separate potential markets here, and the existence of a market in one does not mean that a market in the other should by rights also exist. The true question is only whether the kidney should be treated as a commodity, for which more below.

I'm not so concerned about the plight of the poor doomed surgeon. The circumstances feel too much like a particularly contrived episode of 24. In real life (presuming such an insidious disease exists) she would undoubtedly be given the chance to keep working to take her mind off her unfortunate condition, or else paid sick leave for the last few days of her life on compassionate grounds. In the latter case another surgeon would perform the transplant. Nothing sacrificed here, m'lud.

On to your second post. My point is that if we think it is morally justified to obtain more kidneys than can be collected simply by appealing to altruism, then it is unfair to harvest organs from the poor by financially incentivising it. We should instead harvest organs from everyone by legally requiring it. It is only a fair system if we're all in it together.

I have absolutely no trouble with blocking people from selling their bodyparts, for much the same reason as I have no trouble with blocking people from selling themselves into slavery. Your body is not an asset to be bought and sold. If it were, there should be no moral objection to being forced to sell a kidney to pay off a debt (and I trust you would have a moral objection to that).

And finally...

" since people could just sniff and argue 'They should just sell a kidney' "

You've put your finger on the problem, right there. It's the tyranny of the sniff.

Gooder said...

Ok, say the organ trade is legalised, who do you think will end up being those that give up their organs?

I have no doubt it would be those in poverty since no-one else (bar, say drug/gambling addicts and well thats no better really) would have cause to sell their body parts.

(Anyone with a big enough personal reason will donate anyway)

We are looking people who already work nose to the grinder to earn a basic living, and probably I suspect actually imigrants who barely get by, those at the very fringes of society.

Now once the trade is legal it is these groups that will be targeted and pressuried by others to sell and sign away body parts and for prices that I imagine won't be great.

After all if someone is desperate for money and a firm can get away with giving them $5,000 instead of $10,000 they will not even blink.

What is a lung or kidney even worth?

Personally I don't think parts of people's bodies is something that should be thrown out onto the free market.

I also suggest people watch Dirty Pretty Things (http://www.imdb.com/title/tt0301199/plotsummary) for an idea of the state of things as they are (and I only see legalisation giving lease for it to occur on a bigger scale).

Yes, saving more lives is a noble cause but you have to be careful it's not at the expense and misery of thousands more.

SpaceSquid said...

"I have absolutely no trouble with blocking people from selling their bodyparts, for much the same reason as I have no trouble with blocking people from selling themselves into slavery. Your body is not an asset to be bought and sold. If it were, there should be no moral objection to being forced to sell a kidney to pay off a debt (and I trust you would have a moral objection to that)."

Anything that can be freely sold would have to be eligible for re-possession? Yeah, I'm not sure there's a counter to that one. Good move. And sniff tyranny makes me more nervous each time I think about it.

"and I only see legalisation giving lease for it to occur on a bigger scale"

That, I'm not convinced about, Gooder. Once safe and legal alternatives exist for the option, the misery quotient would be far more likely to decrease rather than increase.

Gooder said...

Why would the misery decrease? You'd still arguably have the same people selling thier organs mostly because they are desperate. Legalsiation when only make it more common if you ask me as organ brookers will no doubt go out and target these people and pressure them, so you get people wouldn't have done it in a an illegal setting now pressurised into it.

I do see organ chasing brokers much like you get ambulance chasing lawyers.

For me the issues involved for the individuals run to a lot more than if it's being done in a back street drive versus a nice clean hospital. It's more than the operation itself that makes it a misery.

It's the fact it's you're putting yourself through an exhasuting and incredible stressful process than leaves undoubtedly worse off health wise in the lung run because it's your only option to get enough money to survive in the long run. That's the misery.

SpaceSquid said...

Oh, there is one potential wrinkle in the repossession argument, which is that our society already seems fine with the idea of legally forcing people to do jobs (as community service), but we still don't sentence people to perform dangerous jobs. Those are still strictly voluntary. On balance I still think the point is a very valid one, but that was just something that floated into my head whilst shopping.

"I do see organ chasing brokers much like you get ambulance chasing lawyers."

This is true. Whether or not the money we save by not having to chase up illegal operations (and/or taxing kidneys, which is a whole other issue) could be used to prevent this, I don't know.

"It's the fact it's you're putting yourself through an exhasuting and incredible stressful process than leaves undoubtedly worse off health wise in the lung run because it's your only option to get enough money to survive in the long run. That's the misery."

Exhausting and stressful, undoubtedly. I'm not sure I'd necessarily attach misery to it on top of it. Certainly, if people are choosing this option over the alternative, it it theoretically reducing misery. They are choosing what they believe to be the better of two crappy options. When you first mentioned the idea, I assumed that you meant the misery of illegal organ harvesting, which is much more risky both in health terms and in the chances you'll ever see your money at all. The former risk would be much reduced, and the latter eliminated.

Furthermore, while on the subject of health, I'm not medically qualified to judge whether losing a kidney makes you less healthy, or simply more susceptible to various health issues (which I don't think are the same thing), but it's entirely worth bearing in mind that the financial consideration for selling a kidney might well be the need to afford some other health treatment. If the chemotherapy you need to blitz a tumor can only be afforded by selling a kidney, the exchange will make you more healthy, won't it?

I acknowledge that this specific example is dodgy on two grounds, I have no idea if the costs would balance, and I have no idea if giving someone chemo whilst they only have one kidney is in any way a good idea, but I hope the general point is clear.