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Repugnance is Repugnant
Many people find the idea of selling human organs for transplant to be repugnant which is why Roth argues that we should focus more on improving efficiency through kidney swaps. I'm all in favor of swaps and have also suggested that one argument in favor of no-give, no-take rules is that they are ethically acceptable to more people than organ sales.
Nevertheless, I think Roth assumes too quickly that repugnance is a constraint to be respected rather than an outrage to be denounced and quashed. People's repugnance at inter-racial dating or homosexual sex is no reason to prevent free exchange - the same is true for organ donations. Repugnance itself can be repugnant.
Is it not repugnant that some people are willing to let others die so that their stomachs won't become queasy at the thought that someone, somewhere is selling a kidney?
What people think repugnant can change rather quickly with changes in the status-quo. Adam Smith said that in his time there were "some very agreeable and beautiful talents of which the possession commands a certain sort of admiration; but of which the exercise for the sake of gain is considered, whether from reason or prejudice, as a sort of public prostitution." What were these talents that people in Smith's time thought akin to prostitution? Acting, opera singing and dancing. How primitive, how peculiar.
In the not to distance future I think people will look back on the present and think us primitive and peculiar. Letting thousands of people die while organs that could have saved their lives were buried and burned. So much unnecessary pain; all for fear of a little exchange. How primitive, how peculiar. How repugnant.
Posted by Alex Tabarrok on November 16, 2007 at 07:31 AM in History, Law, Medicine, Philosophy | Permalink
Comments
very good article!
Posted by: at Nov 16, 2007 7:48:49 AM
Agreed. Go Life Sharers!
http://www.lifesharers.org
Posted by: chug at Nov 16, 2007 7:51:02 AM
Of course, those professions Smith mentioned are *a little* like prostitution. What's hypocritical is a) not to note that so are many behaviors that were not seen as objectionable in his time, such as marriage, and b) not to investigate whether the similarities are such that the reasons for objecting to prostitution are rightly transitive. Bad associations are a bad basis for policy. However, the analogy clearly falls harder on our time than on Smith's. Opera etc were obviously not illegal in Smith's time, though of course much earlier the Globe was blamed for the plague in London and forced to move a little.
Posted by: michael vassar at Nov 16, 2007 7:52:14 AM
People that oppose ideas that might get people the organs they need are repugnant.
Posted by: Mcwop at Nov 16, 2007 8:23:03 AM
The should make TV ads with people about to die because they can't get a kidney. This is crass, but find people near death and make ads calling for the legalization of organ sales. Get a bill up to the state legislature or Congress. Hopefully they pass it, but if they don't, run the ads again and again— except at the end, it will inform the viewer that the people they saw in this ad are already dead. Then put someone new in the ad at the end, who needs a kidney soon. When people see how long that ad gets after a few months, their opinions will change.
Posted by: 8 at Nov 16, 2007 9:27:31 AM
So....what other thinking about unintended consequences has Alex done on this issue? Would the cost of instituting organ-commerce be cheaper than not?
Suppose we legalize this.
What rules get set up to handle the contracts?
Do we allow pay-day loan-style organ donation outfits?
Do we allow people to recruit for donors on college campuses?
Do we allow people to ethnically advertise organs?
What do we do with surplus organs?
What rules do we set up for international organ donation?
What bad things can happen if we successfully institute organ commerce?
I don't hear this kind of thinking addressed. Alex's article is idealistic, which is fine. But I'd like to see people discuss the details, limits and unintended consequences of this, particularly from an economic view or model.
Posted by: irtisaam at Nov 16, 2007 9:28:17 AM
Actually, Mr. Vassar, from what I understand, public singing, acting, dancing and such were illegal in Scotland during Smith's time. Scotland and England did, and still do, have separate legal systems. Furthermore, stripping or exotic dancing is "*a little*" like prostitution, while opera, drama, and other sorts of entertainment are nothing like prostitution. The argument that all people who are paid for entertaining others are "*a little*" like prostitutes means that writers, composers, and arguably scholars are all "*a little*" like prostitutes since their main focus in producing services for others to enjoy (and which they do not, strictly speaking, need).
On a more relevant note, I whole-heartedly agree with Alex's assertion that repugnance is often used as an excuse to perpetrate or perpetuate harm on others. Those enforcing the ban on organ sales likely do not bear the cost of that ban, which is also problematic.
Posted by: KWA at Nov 16, 2007 9:29:41 AM
Very well said!!
On other points:
Basically all paid employment is "like" prostitution as it involves renting ones body and mind for the performance of activities directed by others. I think the right response to the prostitution analogy is to ask what is so bad about prostitution.
The discussion of institutional designs sought by one commenter is well established in the literature.
Jeff
Posted by: Jeff Smith at Nov 16, 2007 9:36:25 AM
irtisaam
Trade in parts of the human body (for sale or donation) produces difficult to evaluate choices. Your concerns are real, but could be minimized through creating the right markets structures (surplus organs are easy, they'd remain inside their hosts--living or dead).
Under the current system, how many donors are not given the same level of care as non-donors because for good (desire to help) or nefarious reasons (desire to be paid for the transplant)?
Economists generally understand that every structure creates incentives, and believe that by minimizing the transaction costs allows agents to best weigh the full impacts of any decision.
It often seems their critics only see the incentives created by money.
Posted by: nelsonal at Nov 16, 2007 9:55:50 AM
irtissam: As a practical matter we do not legalize anything, we can only institute laws that make certain actions illegal. Repeal of this law is all that is necessary to allow those who sell organs to avoid prosecution for their actions. Secondly, if you wish to outline specific downfalls to the selling of organs (that cannot occur via a simple transplant) that are not already covered by other laws (e.g., stealing organs for profit is already illegal) please mention them. Otherwise, the contracts will be setup in such a way that both the seller and the buyer (who may indeed not be the actual patients but hospitals) that both parties can agree. For example, those who would otherwise provide their organs for free may either donate their organs in agreement for a paid-funeral OR may donate them as charity just as they are coerced to now.
Just as we assume innocence until proven guilty government is directed by the Constitution to assume freedom until such freedom is intolerable or infringes upon another's freedom. If the reasons for a law are no longer necessary or otherwise deemed (given current knowledge) invalid that law MUST be repealed and freedom given back to the people WITHOUT proving that such freedom is necessary. Let freedom play out and keep an eye of the ramifications of such freedom (generally expressed via civil courts) and then, if abuses are occurring specifically target those abuses. It is impossible to have perfect foresight but freedom of all parties to choose and bargain in their interests as opposed to government restrictions is the foundation that our country is built upon and thus is the legal and proper position for our government to take.
Posted by: David Johnston at Nov 16, 2007 10:09:59 AM
Excellent, excellent, excellent.
Posted by: Daniel Klein at Nov 16, 2007 10:11:40 AM
If I give up a kidney to save another, I am putting myself at increased risk. I will no longer have a "spare" kidney and won't be able to survive if my single kidney fails. In addition, I will be put at considerable risk during the surgery over and above what I would be risking by not undergoing surgery. I don't see what is so unreasonable about wanting to be compensated for this significant risk.
On the other hand, by allowing the sale of organs, you would put poor people under pressure to sell their organs for money they need to support themselves or their families. Would it be then become immoral not to sell your kidney to support your children if you are very poor? I don't like the idea of people feeling obligated to sell their organs...
On the gripping hand, if selling organs is illegal, then no one gets to make the choice and those who need organs who might have been able to buy one will not get an organ no matter what.
Hopefully we will be able to clone organs before long and the question will become moot...
EI
Posted by: Earnest Iconoclast at Nov 16, 2007 10:15:22 AM
David Johnston,
Thanks for saving me the time of making my own lengthy response. You are right on, the onus is on those who would take away our liberty to present compelling evidence why we should give up those liberties. It is disturbing (albeit not surprising) to me that anyone could think otherwise.
Earnest Iconoclast,
You basically answered the quoted point in your next paragraph, but I want to expand on it anyway.
you would put poor people under pressure to sell their organs for money they need to support themselves or their families
And what kind of (insoluble?) pressure would poor people be under in the absence of such a choice? Perhaps they might rob a liquor store instead, or commit suicide, or walk away from their family responsibilities and abandon "junior".
Taking away choices from poor people seems mindblowingly stupid to me. Surely the more options they have the better. And when you consider the full tradeoff, to object to someone poor giving up a spare kidney you must by definition prefer the death of a counterpart who is thus unable to get a transplant. Are you really willing to make that tradeoff?
Posted by: happyjuggler0 at Nov 16, 2007 11:22:20 AM
Slavery is repugnant.
Marriage is considered repugnant to certain groups of people.
Cannibalism is repugnant, except maybe under certain circumstances.
Interest was repugnant, but is no longer under certain circumstances, but some think that pay day loans are repugnant.
I am not sure that repugnance as a concept can be thrown out simply because it interferes with exchange. The concept of repugnance often helps to define the sphere of the market. We can make certain objections under normative assumptions. It is hard to ignore that depending on the paradigm of abstraction, repugnance will serve some function that is not being captured by efficiency arguments within a shared but unarticulated normative space.
Posted by: mthomas at Nov 16, 2007 12:19:53 PM
Would you agree to a well regulated organ market for kidneys?
What about the same, but for eyes?
Now, what about the same, but for hearts? (Keep in mind there's no really functional artificial heart at the moment)
Few economists will answer yes to the last one, even though many will answer yes to the first one. Most economists who would support a market for kidneys find some organ transactions repugnant- they just draw the line in a different place.
Posted by: J at Nov 16, 2007 12:43:46 PM
mthomas:
Per Alex above: "...assumes too quickly that repugnance is a constraint to be respected". Repugnance is basically an emotional state based around morals/values. What Alex implies and I agree with is that we as a society are oftentimes TOO QUICK TO ENACT LAWS that a specific subset of the population feels is immoral/repugnant (homosexual marriage).
If our only basis for a law is personal feelings and not the effects of the law (or lack thereof) upon individual liberty then those laws will often affect those in the minority whose actions, while otherwise not interfering with the daily lives of the majority, are found to be repugnant by the majority.
Re: your last paragraph...no one is "throw(ing) out" repugnance but markets are well designed to take repugnance into account and do so at the individual level of the participant instead of a enforcing a value set upon all possible participants (or by making a market illegal removing all participants equally). The fact that the market itself is made illegal and not the transfer OR good is an indicator that the law is flawed. We make (owning people/drugs) illegal, not the actual sale of (people/drugs). Lastly, do you care to give an example of such a "paradigm of abstraction" or you do think using big words in a correctly stated yet utterly indecipherable way to be sufficient to give your thoughts credit? Alex and Tyler are doing an excellent job of making economics more accessible to the layperson or professionals of other fields (as I am); your last paragraph is not accessible - at least to me (took a few times to read it and still not positive I understand your point).
Posted by: David Johnston at Nov 16, 2007 1:07:42 PM
J-
I don't have any problem with a "well-regulated" market in /any/ organ - kidney, eye or heart. The straw-man that you are erecting is that such a market in hearts would necessarily require murder. No, it would not. I can easily envision a well-regulated market in organs where origin and provenance is absolutely required, and excising a beating heart (from an otherwise healthy individual) is prohibited. You know, much as it is today, but where you can actually buy the bloody thing.
Posted by: C at Nov 16, 2007 1:07:44 PM
C- so you are not in favor of allowing people to sell their own hearts, then, but you are in favor of allowing people to sell their own kidneys? The essential point of the question was that distinction, not whatever else you read into it.
Posted by: J at Nov 16, 2007 1:14:30 PM
J: It doesn't take an economist to create a market (in fact, entrepreneurs generally create markets and later economists come in and describe why the market exists). So, the question really is whether a market for hearts is repugnant but either (a) why doesn't one already exists when in fact there is a need or (b) theoretically what would such a market look like. If and when such a market exists economists can help define the various incentives present and then society (i.e., government) can introduce their own incentives/disincentives to smooth out the edges.
Sure, the economists that find such a market repugnant will not spend THEIR time researching and theorizing about such a market but because those that are interested in looking at such a market would not find a receptive governmental audience they have DISINCENTIVES to do the research that could benefit our society. Yes, we all have lines that we draw when it comes to values; but too often those lines are instead drawn by others.
A working market example on the beating heart: If I go to the hospital and have surgery and would otherwise die why not have a contract signed by myself available saying that anyone who agrees to this contract and will pay my heirs $10K for my still beating heart (I go brain-dead, no live support wanted) can have the heart. The hospital acts as an escrow and my power of attorney and buyer can either negotiate OR the contract MUST STAND AS IS to be enforced. Beyond that, if someone can get more for their heart now than they could by living for X years (say terminal cancer, heart is OK) who am I to judge that personal decision?
Posted by: David Johnston at Nov 16, 2007 1:38:10 PM
David- indeed, it doesn't take an economist to create a market and I wasn't trying to imply that it does. Since organ sales are currently illegal in the US, "agreeing to a market" means "supporting the legalization of said market."
I used economists in the example because I have seen that question asked of a group of economists, with the results described, and because economists' answer to shortages in kidneys is often "create a market by changing laws that currently prohibit the sales of organs". But economists who answer "legalize selling kidneys" often wouldn't support "legalize selling hearts."
Posted by: J at Nov 16, 2007 2:01:36 PM
J,
As a minarchist libertarian I am in favor of all kinds of free markets for consenting adults that many unthinking people would have a knee jerk reaction against. Perhaps if they could be sat down and educated they might change their minds, but I can't very well force them to listen to me or other minarchists.
One rare transaction I am opposed to is allowing someone to deliberately kill you for money. I suspect most other minarchists have the same point of view. You could call that hypocrisy if you want, but the anarchocapitalist libertarians I know would argue that being a minarchist is hypocrisy itself and that we (i.e. minarchists) are really a bunch of damn socialists.
Thus, taking both of my paragraphs into account, I am one of those people calling for the end of the inefficient and immoral prohibition on the sale of kidneys. I think there is a very real difference, and perhaps equally important, the vast majority of the American people also think there is a very real difference, and thus including 2 and especially 3 in your example guarantee the rejection of the end of our murderously misguided kidney sale prohibition. Selling one of your own kidneys has a net increase in lives, donating hearts from living donors is a zero sum game, thus selling kidneys has an awful lot going for it that heart sales don't.
I also in favor of the end of the immoral prohibition on donor compensation for the sale of your body parts after death (with proceeds going to your estate), although I am not 100% sold on the idea that it would be all that much more efficient at "saving" lives.
Posted by: happyjuggler0 at Nov 16, 2007 3:57:35 PM
Alex blythely dismisses repugnance at organ sales without consideration of WHY people might feel like that. Worse, then he attempts a guilt trip, accusing them of denying the interests of people hwo might be saved.
Well, Alex, maybe you're not a gun enthusiast, but plenty of people would face confiscation of their guns with great repugnance. Would you blythely dismiss their repugnance? Would you then attempt to guilt trip them with statements about how many people would not then be shot by guns?
I don't know why anybody would admire an empty rhetorical argument like Alex's.
Posted by: Mike Huben at Nov 16, 2007 4:04:08 PM
happy: Just curious where you stand on assisted suicide (and the concept of suicide and one's right to control their life/death)? Using the word "murder" has a connotation that emotionalizes the actual action which is suicide (controlled death).
If you measure the game solely on the basis of lives then yes, heart donations are zero-sum, but our society already places a monetary value on lives so why - if your life monetary value (LMV - with a working heart) is greater than mine (with my heart - because I am near death...) - cannot I attempt to salvage some of that discrepancy though the sale of my heart before it dies?
While somewhat callous this also benefits society since if a breadwinner for a family were to die in such a way (in this case 2 breadwinners without the heart transfer) then society is most likely to pick-up the slack (now for the poor person with the good heart, later for the wealthy widow who outlives the life insurance/inheritance because the spouse took early retirement). At least this way the transfer has an immediate net positive impact for the poor person and give the richer person the ability to continue earning (and maybe providing for the poor family in addition to their own).
Personally the right to life is a personal right, not one that must be enforced by society at all costs. Failure to act to extend ones life (through life support, advanced drug research, etc..) is NOT the same as explicitly shortening ones life. The later is generally illegal while the former is enforced through government at the cost to all citizens by the religious majority in this country. While that majority likes to think the issue is a black/white issue the reality is that gray exists in that is as much as in any other (or more-so). Lives are intertwined intrinsically but the religious majority intentionally intertwines them even more in attempt to force governments to become involved when in fact the question often boils down to whether we should impinge on someone's freedom for the EMOTIONAL benefit of others. Given that emotions are transient and change is constant I do not feel that emotions should be a significant factor in restricting my freedom. You want people to act for the emotional benefit of others then toss them a carrot and put away the stick; otherwise they may just go out and look for a bigger stick.
Posted by: David Johnston at Nov 16, 2007 4:40:42 PM
I don't know why anybody would admire an empty rhetorical argument like Alex's
The answer is easy. His argument is not empty, it is a defense of individual freedom. Of course if you dislike individual freedom then your point might make sense.
Posted by: happyjuggler0 at Nov 16, 2007 4:45:56 PM
Due to the nature of the comments on this post, I thought that a link might be in order. Robin Hanson's paper "Warning labels as Cheap Talk" does an amazing job of surveying the literature on the subject of paternalism. His paper is very accessible and fun to read.
link: http://hanson.gmu.edu/bandrug.pdf
I would suggest this as an excellent resource for further foundation of thoughts and starting points for detailed analysis. Repugnance, I would suggest, is related to Unconscionably and Paternalism (two issues appearing in a variety of conversations).
Posted by: mthomas at Nov 16, 2007 4:54:07 PM
