TCS Daily


Valuing Organs -- Literally

By Emily Sands - August 27, 2007 12:00 AM

A horror rock opera with Paris Hilton? The emphasis must be on "a horror."

Indeed, the futuristic musical, announced by the Associated Press, is about a dystopia in which characters must purchase new organs if they are to survive a plague. It foreshadows the most visceral fears of a market-based organ procurement system - right down to the fear that the organs, once transplanted, could later be repossessed.

Given an ever growing wait list - and death toll - among patients in need of a kidney, such an unrealistic plot risks diverting Americans from the real question: How can we solve the kidney shortage?

The 1984 National Organ Transplant Act (NOTA) prohibits the exchange of organs for "valuable consideration" - cash or in-kind payments. It assigns the market for kidneys a zero price ceiling and almost surely reduces potential supply as a result. Meanwhile, demand for a transplantable kidney is high because the only alternative is dialysis, a relatively poor substitute. The combination of short supply and high demand leaves the wait list at over 72,000 - and growing rapidly. Last year alone, the wait list grew by 5,400. And that growth captures only half of the tragedy. In the next 24 hours, an average of three patients on the wait list will become too sick to transplant; another twelve will die while waiting.

Real solutions to this dire shortage are at hand. Among them are presumed consent for deceased donors and tax relief or other financial incentives for living donors. Advocates of these solutions face an uphill battle against the notions that presumed consent or incentives would undermine human dignity or exploit donors. But even the most vocal of opponents - the National Kidney Foundation prominently among them - acknowledge that donated kidneys save lives.

Enter Mary Ann Baily, a bioethicist with the Hastings Center, who challenges the very foundation that transplanted kidneys save lives.

She recently presented her eye-catching views in The Bioethics Forum, a popular, online blog on which she scoffs at "the many proposals for obtaining more transplantable organs." After all, she notes, "the number of living donors is growing."

Baily's faith in the increase in living donors is woefully misplaced. The number of patients in need of a kidney is growing far faster than the number of donors. Since 2000, the increase in deaths off this waitlist has averaged nearly ten times the increase in living donations. In the last decade, the number of living donors has grown by 75% over the 1995 level; meantime, the number of deaths off the waiting list has grown by a miserably larger 125%.

It's misleading to tout the rise in living donors, but it's flat-out wrong to assert that "more living donors are providing organs to people they don't know." According to the United Network for Organ Sharing (UNOS), the number of unrelated, anonymous donors has been falling consistently over the last three years. Although there were a mere 84 unrelated, anonymous donors in 2004, there were only 77 in 2005, and 72 in 2006. The unrelated, anonymous donors comprise but 1% of all kidney transplants.

And, like her facts, Baily's fears are off-base. She criticizes the "rule of rescue," which relies on a perceived duty to save endangered life in all cases. The problem? Apparently a donor kidney is not a gift of life. She implies that there's no limit to the length of life on dialysis - the substitute for a kidney transplant. Moreover, Baily fears that the phrase "a gift of life" could "convince society to ignore concerns about whether routinely using living people as organ sources is a good thing."

But a donor kidney is agood thing -- and a gift of life.

What Baily fails to mention is that dialysis is a distinctly imperfect substitute. A study published in The New England Journal of Medicine analyzed over 200,000 patients under age seventy treated for ESRD over a five-year period. The study found that, even after correcting for differences in health before treatment, a transplant recipient lives an average of twenty additional years as compared to a patient put on dialysis. And while the annual death rate in wait-listed patients - most of whom are put on dialysis - is 6.3%, the annual death rate in transplant recipients is just under half as large. As long as an additional twenty years of life - or a near halving of the annual likelihood of death - is considered a substantial contribution to life, living kidney donors are, contrary to some bioethicists' interpretation, truly giving the "gift of life."

Interestingly, Baily herself concedes that those "who get kidney transplants do have a longer life expectancy than people who stay on dialysis." So either her argumentation is inconsistent - in which case readers should be skeptical of her claims - or she excludes higher life expectancy in her definition of "giving life" - in which case she would need to exclude not only kidney donors, but also bone marrow, heart, and lung donors.

Without offering any solutions to the kidney shortage, Baily asks, "Do those advocating for living donation realize how many other ways there are to improve quality of life and increase life expectancy that do not require a step as extreme as surgically removing a living person's kidney?"

Yet cost-benefit analysis reveals that there are far fewer than the optimal quantity of kidney donations. In fact, the marginal costs to additional kidney transplants would likely be negative:Additional transplants save money as compared to dialysis - estimates range from between $60,000 to $250,000 per patient over a five-year period. In all, Americans currently spend about $11.1 billion annually on dialysis. Even with the low-end estimate, if the over 72,000 renal patients on the waitlist could each receive a kidney, the ESRD program, which covers treatment costs, would cut costs by nearly half - saving Medicare over $4 billion.[1][1]

And while it is true that some burden would inevitably be borne by the donors, they could - and should - be compensated for their donation. These costs would average markedly less than the money saved with each transplant.

The only qualm with using the expression "gift of life" to describe donor kidneys ought to lie not with the word "life," but rather with the limiting word "gift." As evidenced by the unnecesarily long waitlist for kidneys alone, the "gift" of life does not incentivize enough living donors. The "gift" must thus be complemented by other mechanisms, including valuable consideration. Ms. Hilton's character may portray incentivized kidney donation as horrific, but the true horrors lie with the thousands of annual deaths that could - and should - be averted.

Categories:

70 Comments

Kill NOTA -- Not Patients
None of Mary Ann Baily’s arguments are rationally convincing, and most appear to be based on factual ignorance and/or manipulation.

But the real issue is CHOICE…can a citizen provide a body part for compensation. This is nearly identical to the question of whether a citizen can offer their home, their car or their stock for compensation. Home, car and stock sales are allowed but regulated. There is no compelling reason to treat a body part any differently.

NOTA is a law based on fear, ignorance and delusions of grandeur. It is regrettable that such legal abominations have not been struck down by the courts. Congress should replace NOTA with a law that ascribes a more appropriate value to the liberty and integrity of its citizens.

Complete rubbish
"Home, car and stock sales are allowed but regulated. There is no compelling reason to treat a body part any differently."

You don't need houses, cars or livestock to live, but you do need at least one fully functioning kidney, so your comparison is wrong.

So you suggest payment for organ donations. So I presume this means that the rich get to live long and happy lives and the poor do not?

Who Decides
I claim ownership of my kidneys and my home. If I wish to sell one of my kidneys or my home, who are you to catagorically prohibit either sale?

Answer: you have no standing or justification for such action, and neither does the Congress.

Don't be naive
Nice attempt at reversal but it won't work. Do you claim the right to buy any such body parts? Good luck with that argument.

This isn't about the middle class selling body parts, it's about organ harvesting in the third world imported into the US or from the poorest classes in the US having supposed sales extorted from them. Your sanctimony on a point of supposed freedom is absurd. By your token, the slave trade would still be legal "I claim ownership of my kidneys, my property and my home". Fortunately, more sensible views prevailed back in 1865.

Positive Sum
"So I presume this means that the rich get to live long and happy lives and the poor do not?" -Colin (No pun intended.)

Presumably, 'the poor' would rather have the money and 'the rich' would rather have the kidney. Who are we to say that a person can't choose to sell an extra kidney if given the opportunity. If I could go through a week-long recovery and a few months of abdominal pain to send my children to six years of college, I'd do it.

If I was dying of some other disease, and could guarantee that my family would have money after I'd gone, why wouldn't I want to sell off healthy rgans to support them? Why should you want to stop me?

If I could live another 20 years by purchasing an organ to keep me alive today, why wouldn't I want to borrow the money and pay it back over time? Why would the regulators choose to stop the practice? It would be unthinkable and repugnant if the exchange were forced, but when free citizens enter into an agreement of this sort willingly both benefit.

Slave Trade
Good analogy:

"By your token, the slave trade would still be legal." -Colin

The slave trade was repugnant, because the exchange was not a willing one. But when former slaves chose to do the same labor for fair compensation, it was no longer an evil. Contrary to popular belief, former slaves were quite successful in improving their standard of living in the decades following the abolition of US slavery.

Incidentally, I don't see this issue as black and white. I don't find the libertarian argument compelling because such a system would not be isolated from the larger community. The impacts on society at large have to be considered, and it's possible that our institutions are such that a functional organ trade would benefit individuals yet have some negative consequences in the way that we as a greater community value our bodies and our lives. (Much as prostitution arguably has a negative impact on the way we value family and marital relationships.) Still, I expect that this is a boundary case and it would make sense to relax some of the restrictions because we already share the goals of providing better health and opportunity.

More innocence
"It would be unthinkable and repugnant if the exchange were forced, but when free citizens enter into an agreement of this sort willingly both benefit."

Just what do you think is going on in parts of Asia and Africa? Extreme poverty makes just about every such exchange enforced even without it being compelled by armed gangs.

"...when free citizens enter into an agreement of this sort willingly both benefit." I'm sure the folks being sold into slavery to Dutch, Arab or British slave traders in the 17th century thought much the same.

"If I could live another 20 years by purchasing an organ to keep me alive today, why wouldn't I want to borrow the money and pay it back over time?"

More naivete. And what happens when, not if, the price rises to the point that you, an average citizen can't pay it back within your working lifetime? Or to ensure you have sufficient lifespan, to what degree will you allow others to dictate the terms upon which you live?

Quite right
I agree with you. This is a very murky area indeed with some potentially deeply repugnant possible outcomes. By the same token I am deeply supportive of medical technology that can or holds the prospect of extending the duration and the quality of human life. But in no way can we allow this to become a Soylent Green nightmare through libertarian principles taken to absurd extremes.

what's the difference
Do you believe that it is the proper duty of the state, to keep consenting adults from doing things to harm themselves?

If so, how are you different from the average liberal?

Dialysis vs transplant
One cannot simply compare transplant survival vs survival of those on dialysis.
Many of those on dialysis are not candidates for transplant: They have end stage Diabetes, and often die of heart attacks or infections. Many are elderly.
That's why they aren't offered transplantation.
Other end stage renal failure is from collagen disease which also has a higher mortality from other organs being affected. (eg Lupus). Some are not offered transplant because the disease will also result in their new kidneys failing from the same disease. And then there are those who would not comply with medicine and are high risk for transplant failure...some are on dialysis awaiting their second or third transplant.

You have to compare dialysis vs transplant mortality in the same population to get an accurate figure...such as a young person whose kidney failure is from a kidney problem without other organs involved.

to Colin re rubbish
If you check it out you will find that the rich do, and always have, got to live longer and healthier lives than the poor. This also applies to the former communist countries where the rich had access to better care than the poor. This also applies to present day Cuba, where Castro had a specialist doctor from Spain flow in to care for him, and the the captive people in Cuba don't. Now what if we had a bet about whether Kim in north Korea has better care?

to Colin re Soylent green
Crappy comparison because in Soylent, they weren't voluntarily doing it, whereas libertarians and capitalism emphasizes free choice.

organ shortage
The reason for organ shortage is the same as for any other shortage in the world, like enough food in north Korea; because it's a government created one because of interference in the economy. There should be a free market in kidneys, then the shortage would disappear immediately. I find it odd that the women's libers aren't advocating it too since they always say that a women's body is hers to do with what she wants like even kill her baby by drilling a hole thru its head when its being born; so why would she also advocate selling one of the organs she doesn't even need?

Just because
...the poor can't afford it the rich isn't entitled to a new kidney and so in effect condenming both rich and poor to death.
Furthermore this is not an issue of rich or poor but values. Some people will value twenty extra years more than a new car or a holiday to Europe.

Extreme Poverty
Just what do you think is going on in parts of Asia and Africa? Extreme poverty makes just about every such exchange enforced even without it being compelled by armed gangs.

You're probably right about what's going on in parts of Asia and Africa, but few if any people in America today would be so compelled. This nation is not exactly replete with debtor's prisons. So, as someone has already said, why not have a regulated market instead of an entirely closed one? We can prevent people from being economically "forced" into selling their organs without forbidding them to do so entirely.

"...when free citizens enter into an agreement of this sort willingly both benefit." I'm sure the folks being sold into slavery to Dutch, Arab or British slave traders in the 17th century thought much the same.

I'm sure they did not. Do you understand the words 'free' and 'willingly'?

And what happens when, not if, the price rises to the point that you, an average citizen can't pay it back within your working lifetime?

If that happens, I won't be able to buy a kidney. A horrible, horrible fate nobody should have to face, I'm sure you would agree!

Or to ensure you have sufficient lifespan, to what degree will you allow others to dictate the terms upon which you live?

Whatever degree I choose. Who are you to make that decision for me?

No Subject
Do you claim the right to buy any such body parts? Good luck with that argument.

Thank you for wishing me luck. Yes, I claim the right to buy such body parts from a free, willing, able-minded donor. The transaction would be to my benefit as well as to his (in his able-minded opinion). Who are you substitute your judgment of what is good for him for his own?

This isn't about the middle class selling body parts...

Yes it is. Right now it is illegal for the middle class to sell body parts. Emily Sands thinks it should be legal. That is what her article is about.

This isn't like prostitution
Legalizing prostitution wouldn't save the life of anyone who is currently dying.

I suppose it is possible that an organ trade would negatively affect how we value our bodies and our lives. But why would it be likely? Whose to say the impact on perceptions of value would be negative rather than positive?

existence, meaning, the universe and the mystery of human life
Everyone knows the Constitution protects the right to make choices about your body based on your "concept of existence, of meaning, of the universe, and of the mystery of human life," because these are "intimate and personal choices" that are "central to personal dignity and autonomy" and involve "personal autonomy and bodily integrity." [Casey vs. Planned Parenthood] That is, as long as you are choosing whether to have an abortion. Try to do anything else with your body, and suddenly the alleged effects on society as a whole somehow become ever so much more important.

More naive notions
"You're probably right about what's going on in parts of Asia and Africa, but few if any people in America today would be so compelled."

Wrong. Rich countries like the US are creating the lucrative market that makes these practices attractive for some human vultures. It's why the prohibition on sale and purchase is necessary.

"If that happens, I won't be able to buy a kidney. A horrible, horrible fate nobody should have to face, I'm sure you would agree!"

Given the above, what you left unanswered is who dies so that you live.

Given the trade
in organ traffic that exists now, why do you believe that much of it has anything to do with free choice now, let alone if prohibitions are lifted?

No
it is the proper duty of the state to prevent economic advantage from doing undue harm to others.

Of course
the rich generally enjoy longer and healthier lives than the poor. That's no reason to put in place a trade in human organs that further encourages such disparity based on ignorance and short term needs.

who gets define when economic advantage is too much, and who gets to define what is harm
why do you believe that you get to use the power of the state to enforce your definition.

The liberal believes that it is the duty of the state to ensure that those in economic need as well.

That's why they refuse to let poor people work in jobs for less pay than the liberal believes in.
That's why they oppose putting factories and refineries in places where land values are cheap.

in that vein
why shouldn't a person who is dying anyway, enter into a contract to sell his organs to the highest bidder?

Give organs first to organ donors
Over half of the 97,000 Americans on the national transplant waiting list will die before they get a transplant. Most of these deaths are needless. Americans bury or cremate about 20,000 transplantable organs every year. Over 6,000 of our neighbors suffer and die needlessly every year as a result.

There is a simple way to put a big dent in the organ shortage -- give organs first to people who have agreed to donate their own organs when they die.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren't willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

undue harm?
How do you tell if harm is undue?

All true
but it doesn't deal with the substance of my comment. You know as well as I do that the purpose of the state is to make decisions in the interest of its citizens. Why do you believe that individuals should be allowed to wield their economic clout to the disadvantage of others without any hindrance whatsoever? More succinctly, why do you believe the state should follow your definition?

Make no mistake, I'm not talking about socialism here which is redistribution/expropriation of wealth. This is about using wealth to expropriate the life of others. As to factories, of course, but there is a very large difference between location of economic entities and traffic in human body parts.

Naive?
Colin,

When your responses in this thread start showing evidence that you understood what people were saying to you, I'll entertain the possibility that I am being naive. Let me give this one more try:

What I said was that poor people in America are not generally in such dire straights that they would be economically compelled to sell their organs. You assert that this is wrong. Why?

I suggested a regulated market that ensures donors are not being coerced. It seems possible to certify that a donor is willing and is not being manipulated. You say this is naive. Why?

You worried that if organ sales are legal the average citizen won't be able to get them. Your remedy: outlaw sales altogether! You seem to think the average citizen will be better off if it is illegal to purchase a lifesaving transplant than if it is merely expensive. Why?

You also seem to think it is okay for rich people to die. Throughout this thread, you have refused to acknowledge that it is worthwhile to help rich people live longer. Why?

Please respond with more than just the statement that I am wrong, or not at all.



Fair enough
I will try to answer the questions and thoughts you pose.

First, there is an underclass in America that can be coerced, namely the illegal immigrants. They have already been in many cases compelled to work in environments in the US that do not meet federal labor laws, so I can't see why other forms of economic coercion will not apply.

Second, because there is already a black market in this area it is not clear to me that a regulated market would solve this. What a regulated market does is legitimize the purchase of organs which may in turn increase, not decrease black market traffic. The reason I suggest is that demand is always going to greatly exceed supply. Hence the price will rise to ensure that demand and supply meet. To the extent that the market is regulated to restrict price increases only affordable by the rich, or restricts supply for various quality or moral reasons, to that degree will a black market flourish to undercut the requirements of a regulated market. I don't view this as a problem internal to the US so much as I do black market imports from outside the US where production may be done under circumstances which could only be described as abusive.

Your third question is also a serious one and deserves a serious answer. My reply is akin to that of Henry Ford who realized that cars would never develop in the US unless his workers were able to afford one. Same thing applies here. Organ sales can only work if it is at a price (hence quantity) available and affordable by all. At this time, given the insane waiting list for transplants, it is not clear to me that such is or ever will be the case.

Your fourth question is also interesting but a slight misunderstanding of what I said, or perhaps not quite the complete thought of what I said (I may not have expressed it fully). It is not that I think it is OK for rich folks to die. It is that I think it unfair for them to live at the expense of the shortened lifespan of someone else. Like it or not, it is a fact that selling a redundant organ measurably and significantly increases the risk of mortality. I dislike the thought of any individual using economic leverage to increase their lifespan with the direct consequence of reducing someone else's. Yes, I realize this is a dangerous place to go. To what degree does the state protect people from their own ignorance or economic desperation. This is a moral question requiring a collective answer, to which the state has provided an answer thus far which is an absolute prohibition. Until I see clear evidence that my concerns are not justified I remain supportive of the government ban on trafficking.

Thanks for the reply
You raise some interesting points. I agree that migrant workers are generally susceptible to coercion since they have limited recourse to law. However, it still seems a stretch to suppose they could be somehow economically forced to give up their organs. There is a big difference between ignoring OSHA regulations and cutting out chunks of your body. Many illegal migrants have jobs, and even those who are unemployed are generally not living on the brink of starvation. They might choose to sell a kidney, but it would be a free choice as long as nobody can manipulate the circumstances to make it their only viable option. I remain unclear on exactly what mechanism consequent from legal organ trading would allow the unscrupulous to do so. If somebody wanted to force illegal aliens to give up their organs, how would the presence of a legal market help them get away with that crime? If there is something about legal markets that would aid villains, can we not fix the problem without completely closing the market?

As for the black market, the degree to which it would thrive in the presence of a regulated legal market depends on the type of regulation undertaken. I strongly suspect you have in mind a more invasive regulatory bureaucracy than I. Price-controls do indeed encourage black-markets, which is one good reason to reject them. On the other hand, if the regulation consists only of ensuring the free and informed participation of all parties (i.e. avoiding coersion), price and supply will meet and the black market will shrink. It is also worth pointing out that legalizing this activity, which you say is already going on anyway, would make the procedures tremendously safer and more lucrative for the donors, since they would have legal recourse if mistreated.

Yes, without price controls, the organ transplants would disproportionately benefit the wealthy. That is not, in my mind, the ultimate brand of unvarnished evil some on the left often make it out to be. I think it is better to have life extension available only to the rich than to have it available to nobody at all. Yes, organ trading would hurt the life expectancy of those who sell organs. But remember that they would still have one good kidney (or something analogous) and their life expectancy would not be hurt nearly as much as another person's is helped. Overall, it would result in a longer average lifespan.

The real question here is a basic one about the role of government. I think it is the government's role to ensure that people have an opportunity to make a choice that is in their own perceived self-interest without being tricked or forced, but leave the value judgments to them. If somebody honestly thinks they will be happier with a 70 year lifespan and a million dollars than with a 75 year lifespan and no money, that decision should rest in their hands.

Some believe the government should try to ensure that people make the right choices, whether they want to or not, leaving the value judgments in the hands of government. My question for these people is: why do you think you can make better decisions about someone else's life than they can? And, even if you can make better decisions, by what right do you treat them the way a parent treats a child, rather than respecting them as equals in a free society?

Note that I am not proposing that ignorance or mental disability be exploited in the organ market. These conditions can be addressed by regulations that don't close the market, such as mandatory pre-surgery counseling to ensure that people know the consequences of their actions, and psychological screening to ensure they are of sound mind. I also think trade should be limited to America for the time being, since we would not be able to prevent or screen out coercion in other countries. Nobody wants to incentivize China to ship us all their political prisoners piecemeal. I am fine with the government protecting people from their own ignorance or any frenzied state of desperation; I just don't think it should try to protect them from their own carefully considered decisions.

Finally, I am curious about your claim that organ sales can only work at a price available and affordable to all. I just can't fathom why this would be true. Surely it would be nice if organs were available to all, but why wouldn't the market *work* otherwise?

I think that some of your objections bear consideration, but they can be addressed by means less drastic than prohibiting *all* organ sales. This is getting absurdly long so let me end with one question: setting aside all considerations of poverty, ignorance or other special circumstances, if a middle-class man has a chance to sell his kidney to Bill Gates for a billion dollars, carefully investigates the pros and cons, and elects to go through with it, do you think we should intervene to stop him?

given the trade
Don't understand your question. You say you don't want free chice, "we can't let them". I am simply saying that I do want free choice, which means you could sell those organs you otherwise don't even need. It would immediately end the shortage, but I realize that many people don't like it that people be free, but prefer to control others to do what they themselves prefer.

another reason why not like prosties
With prostitution the girl is only renting out the use of her body for awhile, whearas with organ selling you actually sell, hand over ownership. That's why it's phoney where anti-prostitution fascisss say that girls can't sell their bodies; phoney cus they're not selling them.

of course
Your opinions on this are always from some agrument from morality it seems. All this talk of 'not fair' etc. So your complaint is that the world is not fair. Then since it doesn't correspond to what YOU think is fair, then a government should force people to take your view, as opposed to people being able to make decisions for themselves. Then you say that people are too stupid, so since you are smarter, your opinion regarding freedom should prevail, and forced on others.

comparisions
No need to compare those two things you mentioned. The point is whether consenting adults should be able to do what they want to each other. Like if I have two good eyes but don't read or even appreciate nice sunsets etc. but some really rich guy wants to buy one of my eyes for a lot of money. Then the only matter is that of the price being of more value to me than the eye than I otherwise don
't need. But if some elites say I can't do that, then I think they are my oppressor.

wrong definition
you seem to view the state as everyone's father, and each individual as a child who needs to be taken care of.

The only purpose for the state is to provide those services that cannot be provided by the private market. Things like law enforcement and the common defense.

The idea that the state should be making decisions for people is highly offensive because it assumes that people aren't capable of looking out for themselves.

In this regard, there is no difference between you and any liberal. There's a small difference on which decisions that you would take away from the people, but the motivation is the same.

This is a serious topic
and like many it has very complex ramifications.

"I remain unclear on exactly what mechanism consequent from legal organ trading would allow the unscrupulous to do so. If somebody wanted to force illegal aliens to give up their organs, how would the presence of a legal market help them get away with that crime?"

Good question, here's my response. What a legal market does is legitimize the notion of organ purchase for the purchaser. This in turn, in my view, would lower public resistance to purchase from less ethical sources such as black markets.

"If a middle-class man has a chance to sell his kidney to Bill Gates for a billion dollars, carefully investigates the pros and cons, and elects to go through with it, do you think we should intervene to stop him?"

Also a very good question. However, it is based upon an example of two parties both of whom are operating fully informed of risks and benefits and fully consenting. Unpleasantly I do not believe this to be universally possible. The question then becomes, how can we allow this form of transaction and prevent the other? I am highly uncertain that we can, and unless there is some high degree of assurance in the integrity of such transactions I lean toward outright prohibition. Consider it from a risk/benefit perspective. There may indeed be benefit from allowing such fully informed commercial transactions to take place. However, the downside risks from extortionate practices are very large. Unless they can be mitigated, I tend to view the whole thing as unacceptable.

A further quick thought
"There is a big difference between ignoring OSHA regulations and cutting out chunks of your body."

I agree with you entirely, but we must consider how things may develop and more importantly what precedents we set for the future. It's sometimes surprising and appalling how what seemed to be good ideas at the time morph into something entirely repugnant just a few years or decades later. We see a large difference now, but others may not be so squeamish later on.

Think about it this way, a smuggler says, give me your kidney and I'll get you into the US/through immigration, whatever. Happening outside the US, US law has no jurisdiction.

Don't be silly
we empower the state to make all sorts of decisions on our behalf. That's the basic nature of government, hence this bit from you is wrong:

"The idea that the state should be making decisions for people is highly offensive because it assumes that people aren't capable of looking out for themselves."

Or do you imagine that individuals can run their own national defense, build their own highways, their own power systems and provide their own policing? Please don't waste my time accusing me of being some idiotic socialist. This is just tripe and I expect better from you. We need to acknowledge that all governments exist to make decisions on behalf of us all. The debate is over the scope of things over which governments are empowered to act. Socialists want the list to encompass everything, we want it to encompass a very limited list.

About fairness
You are quite correct to note that the world is not fair, and it is a great error of the socialists to actively try to make it so. The question for me is simply this if you follow in detail the conversation with Melchizedek: should we allow to be put in place a trading system in commodities that would increase unfairness between economic classes?

definitions
that we empower govt to do all sorts of things it has no business doing is not in question.

Whether it is smart, or even right to do so is.

Colinh, did you even read all that I wrote, I quite clearly said that national defense was a proper role of govt. I also quite clearly said that the police power was a legitimate role of govt.

As to people building their own highways without the all seeing, all knowing hand of govt guiding them. Of course I believe that it is possible.

I never stated that you were a socialist, I did say that in your attitude towards the individual, you were indistinguishable from your average liberal.

I reject utterly and without reservation the notion that the role of govt is to make decisions for individuals.
I do this for the reasons I have outlined previously, and which you have not addressed, other than to repeat your tripe that people can't be trusted.

There's an old saying
Liberals want govt to be your mommy.
Conservatives want govt to be your daddy.

Libertarians want govt to treat them like an adult.

Liberals don't believe that individuals can be trusted making any economic decisions on their own, so all of those decisions must be made for them.

Cconservatives don't believe that individuals can be trusted to make any social decisions on their own, so all of those decisions must be made for them.

The odd thing is, both liberals and conservatives believe that people who run govt are somehow smarter and more moral than the rest of us.
Another odd thing is that they both believe (at least for the present) that people are smart enough to choose the people who will be making all the decisions.

Prosties
Prostitution does not have any negative impact on the image of family and marriage any more than violent video games cause kids to murder their fellow classmates or heavy metal rock lyrics cause people to commit suicide. If people are negatively impacted by any of those things or similar things, it's clear this is because they were already effed-up before.

When prostitution is legal, it allows for the healthy release of pent-up feelings. Few people would continue to attend a prostitute if they found someone they could fall in love with; prostitutes aren't home-breakers.

Are there alot of prostitutes who don't want to be prostitutes? Yes. There are a lot of librarians who don't want to be librarians, too. There are lots of people in lots of professions who wish they were doing something else to put bread in their mouths.

But what the poster against prosties probably doesn't want to think about is that there are prostitutes who enjoy what they do. I bet sex therapists enjoy what they do, too. (Sex therapists are merely hypocritical prostitutes.)

Victorian-style sexual repressions, however, are proven to be potentially traumatic.

So, to make a short point longer, the analogy made to the negative impact of prostitution doesn't work, and shows the essay's argument is not understood.

For the record
the slaves bought by the Europeans were already slaves in Africa. Please don't make it sound like evil white men with blunderbusses blundered into the jungles of a foreign continent and rounded up poor, innocent black people who outnumbered them by thousands to one. That's just stupid.

No Subject
"...there is an underclass in America that can be coerced, namely the illegal immigrants."

All of whom deserve to be rounded up and deported. So they're not relevant.

"...demand is always going to greatly exceed supply."

Based on what?

"To the extent that the market is regulated to restrict price increases only affordable by the rich..."

Oh, I get it. Like, what has happened with things like personal computers, and cars, and nice clothing, and healthy food...

"This is a moral question requiring a collective answer, to which the state has provided an answer thus far which is an absolute prohibition."

It is immoral for the state to provide an answer to a moral question.



The Call of Duty
"it is the proper duty of the state to prevent economic advantage from doing undue harm to others."

Are you quoting from "The Onion", or are you wearing stupidity as a clever disguise?

I said no such thing
"other than to repeat your tripe that people can't be trusted."

Moreover

"As to people building their own highways without the all seeing, all knowing hand of govt guiding them. Of course I believe that it is possible."

You are certainly enough of an historian to know that transportation infrastructure has been one of the principal roles of government over the past 5000 years. It may be possible but in practice almost never.

Finally, I wish you would stop lumping liberals and socialists all together. To me liberalism is classical liberalism and nothing else. What you call liberalism is socialism and the two things have virtually nothing in common.

Well
"All of whom deserve to be rounded up and deported."

Good luck with that. It should be fairly obvious by now that simply more enforcement isn't working. It's failing in the US, it's failing in Europe. How often does a policy have to fail for us to stop trying it?

"It is immoral for the state to provide an answer to a moral question."

More naivete. We dump on the state all the time the moral questions that we have trouble with. Where have you been for the last 40 years of debate over abortion laws? All of the disputants run to government demanding that the state take their side in a moral argument. The state gets dragged into deciding moral issues whether it wants to or not, because all sides demand that the state and the legal system rule in their favor.

"Oh, I get it. Like, what has happened with things like personal computers, and cars, and nice clothing, and healthy food..."

Taken a look at your gas and electricity bill lately, especially if you live in New York or California? Hah, regulated markets at work indeed.

Oh about cars, clothing, food, PCs, seems to me those are pretty much unregulated markets compared with gas and electrons.

The problem is this, Dietmar
I want free choice just as much as you do. My concern is that in this particular area, possibly unique among commodities, we may introduce a trade which in fact diminishes choice for some. I've tried to outline some of my concerns in the long posts by myself and Melchizedek.

"introduce a trade"
You don't 'intro a trade', in a free country the default setting is supposed to be free trade. After that only coercive governments can restrict it. Now you sound like every other statist who claims that they like freedom, except in those cases where they don't. And in such cases everyone else should be forced to do your preferences. Some free choice. Your concerns are those of every other oppressor.

"should we allow"
Free trade does not increase unfairness, and beaurocrats cannot presume to make all decisions for all the population. Freedom is more fair. I think it's very unfair of you to want armed thugs(=cops)to force me to be reasonable and do it YOUR way.

TCS Daily Archives