A Stitch in Haste

A favorite pet peeve among many libertarians, myself included, is the silly (and lethal) proscription against selling one's organs. It's "degrading" and "dehumanizing," we are told. It "exploits" the poor, who would get "cheated" by the medical equivalent of loan sharks, in the same way that they are "exploited" by credit card companies and check-cashing offices and H&R Block. It would spawn a new era of medical mercantilism, as we "harvested" organ "resources" from third-world countries only to resell value-added services back to them.

While people around the world, often children, suffer and die. This is somehow a "principled" practice?

At least organ donation is still voluntary, although there is a perpetual shaming moral suasion campaign by the medical community (and the government) to pressure educate people about the desperate need for body parts and tissues (and again, why exactly is the need so desperate?).

Oops, did I say "still voluntary"?

A private member's bill proposing presumed consent for all organ donations is churning up debate in Ontario.

New Democrat Peter Kormos ... says he wants to make it so organs are automatically donated for transplant unless the patient specifies otherwise.

He says the bill is necessary because too many people die while awaiting transplants.

Response to the idea by both legislative members and the public is mixed.

I'd like to propose a compromise: Allow a switch from opt-in to opt-out organ donation, but with a payment. If you die without having gone through the bureaucratic hoops of refusing consent, then yes indeed the government could harvest your body parts, but only after paying your estate some reasonable amount -- say $25,000.

That should cover all the bases. Organ donation skyrockets, the right to one's post-mortem bodily integrity is preserved, no one is "exploited" and no one is allowed to "cheapen themselves" by selling their organs while still alive.

That might be a good first step toward eroding this obsolete, Victorian worldview that refuses to accept organ donation for what it is -- a market.

That's my ruling -- any dissents?

To review: All scarce goods and services must be rationed, if not by a market mechanism then by politicians and bureaucrats. But the rationing will take place. "Universal health care" is an economic and metaphysical impossibility.

Is there any better example of this axiom than organ transplantation: (WSJ - $)

The nation's organ-transplant network is preparing a major change in how it rations scarce kidneys that would favor young patients over old in an effort to wring more life out of donated organs.
...
Today, a donated kidney generally goes to the person who has been waiting longest in the region in which it becomes available, with exceptions made for certain medical factors. A kidney from a 25-year-old donor could be transplanted into a 75-year-old, who is likely to die years before the kidney would have stopped working.
...
The concept is gaining traction among transplant doctors but creating anxiety for some patients and surgeons who worry the new system won't be fair to all. "Is it correct or permissible for the system to say the five or six more years of life that a 60-year-old is going to get are less valuable, less important than the 15 more years of life the 30-year-old is going to get?" asked Richard Freeman, a transplant surgeon at Tufts-New England Medical Center in Boston.

Good question. So good that honest economists (and all libertarians) recognize that it's impossible to answer. Interpersonal utility comparisons are simply not possible. Which in turn means that "social welfare" is a fiction and utilitarianism is a fraud.

I'm not taking sides in the debate between awarding kidneys based on age versus wait times. I'd prefer a market-based system — which, despite the irrational protestations of some that buying and selling organs is somehow "demeaning," would vastly increase the supply of organs available to everyone.

My point here is simply that a "right to health care" ought to include a "right to a kidney." If such a right is impossible (and it is), then so too is "universal health care." Stated differently, "socialized medicine" and "universal health care" are not synonymous. It is not "fear mongering" to use the former term rather than the latter — it is simple intellectual honesty.

All health care — including kidneys — must be rationed. Socialized medicine cannot and will not change that. It will only change the rationing scheme — for the worse.

Yet another example of "try everything except a market solution" regarding kidney transplantation:

Prison inmates in South Carolina could get up to six months shaved off their sentences if they donated a kidney or their bone marrow, under a proposed bill before the state Senate.

"We have a lot of people dying as they wait for organs, so I thought about the prison population," said state Sen. Ralph Anderson, the bill's main sponsor. "I believe we have to do something to motivate them. If they get some good time off, if they get out early, that's motivation."
...
But it is almost certain to prompt fierce opposition from legal experts and prisoner rights advocates about whether inmates are able to make such a decision freely.

Compensating, in a tangible and meaningful way, a prison inmate for voluntarily donating a kidney is an acceptable practice, but compensating, in a tangible and meaningful way, a law-abiding citizen to do the same is somehow "demeaning" and "unethical"? I dare anyone to make that reasoning sensible.

There is nothing more demeaning and unethical than letting people suffer, or die, for no other reason than an irrational belief that markets are somehow "unclean" and must therefore not be allowed to contaminate health care.

(Via Kevin, M.D.)

NOTE: See Update below.

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"If the rich could hire others to die for them, then we the poor would all make a nice living."
--Fiddler on the Roof

I'm not sure what to make of this bizarre story from Holland in which a kidney has become a game show prize:

A Dutch TV station says it will go ahead with a programme in which a terminally ill woman selects one of three patients to receive her kidneys.

Political parties have called for The Big Donor Show to be scrapped, but broadcaster BNN says it will highlight the country's shortage of organ donors.
...
"The scenario portrayed in this programme is ethically totally unacceptable," said Professor John Feehally, who has just ended his term as president of the UK's Renal Association. "The show will not further understanding of transplants," he added. "Instead it will cause confusion and anxiety."
...
"You can have a discussion about if this is distasteful, but finally we have a public debate," [a Dutch politician] told BBC Radio 4's Today programme.

One can draw either of two conclusions from these events:

1. At least there are still some people who recognize the solemnity of the organ shortage, and that not everything belongs on reality TV.

2. On the other hand, if there is so much disgust and outrage over this version of circumventing the status quo, then what chance is there for a sober, non-Simon-Cowell discussion about a less tawdry but no less market-based system of buying and selling organs (which, gasp all you want, would greatly alleviate if not completely eliminate the organ shortage)? This is especially true with kidneys: risky as organ transplant surgery may be, the simple medical truth is that people can donate a single kidney in a way that they cannot donate hearts, lungs, livers and corneas. Why should they not be allowed to do so, and to be paid for their efforts?

If we allowed a "crass" free market for blood rather than insisting upon a "noble"(*) voluntary donation regime, then — crass or not — we wouldn't have a blood shortage. If we allowed a free, or even a semi-free, market for kidneys, then although we might all be less "noble," at least some of us would also be less dead.

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(*) Obligatory link to my posts on the gay blood ban.

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UPDATE: The show was a willful, deliberate, premeditated hoax staged by the Dutch network BNN, supposedly to "shock" the Dutch government, and the Dutch people, into action regarding that country's -- and I suppose all of Europe's -- organ shortage. On that, my thoughts above are unchanged.

As for the use of the hoax scheme, some hasty stitches:

1. To the extent that one buys into the view that broadcast media are not "owned" but "held in trust for the public," then BNN clearly betrayed that trust. One wonders how the FCC would have responded had this been perpetrated by a U.S. broadcast network. (The Dutch cabinet expressly rejected calls to block the program as impermissible censorship. Good for them.)

2. I wonder what the fall-out from BNN's advertisers will be.

3. Is it really the purpose of television to lecture its viewers, or just to entertain them? We already have an excess of activist legislators. Do we really need activist network executives as well?

A law professor weighs in on the concurrent stories of the India kidney scandal and the calls in the U.K. for "opt-out" organ donation at death rather than "opt-in" —

"If poverty and wealth are often unearned, however, it is no less true that good and ill health are often unearned. ... One could, in fact, invoke such desperation as evidence that organ sale ought to be permitted but regulated."

My comment at that blawg:

Of course, a true Rawlsian (or a utilitarian) could even argue that organ donation should be compulsory. And by that I don't just mean after death, as is being proposed in the U.K.

If society is entitled to seize your unearned wealth, then why is it also not entitled to seize your unearned kidney?

And for those who think kidneys are too extreme, how about compulsory blood donations — maybe when you report for jury duty or file your tax return?

See also, "military conscription" — if the state can seize your entire body, then why not just one kidney or pint of blood?

Meanwhile:

Money is clearly the issue in situations involving the human body. Paying young women for eggs to be fertilized and men for sperm is now common practice — even though they are still regularly referred to as "donors." Yet the sale of tissue, cells and eggs for stem-cell research or organs for transplant are still the subject of vehement dispute.

The "vehement dispute" is between those who (correctly) recognize the inherent right to control oneself — an elegant synthesis of freedom of contract and bodily autonomy — and those who (incorrectly) label the revulsion of third parties as "externalities" warranting infringement of the inherent liberty of competent consenting adults.

Strangers to a contract, transaction or other arrangement might be repulsed at the notion of whites and blacks eating at the same lunch counter, or of women working outside the home, or of two gays having sexual intercourse in the privacy of their own bedroom, or of a poor healthy person selling his kidney to an ill rich person. So what? Generally speaking, we (no longer) grant revulsion the dignity of a legal argument or a majoritarian vote.

So too should it be with bodily integrity: what competent consenting adults choose to do with their bodies should not be subject to a "that's just wrong" veto by third parties, no matter how numerous or ardent they may be. Nothing is ever "just wrong." An act either infringes upon the legitimate rights of unwilling others or it does not. But there is simply no "right not to be disgusted."

Finally, I will reprint a "Question" from a while back:

"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?"

That the answer to this question "but of course" is the most modest proposal of all.

(Via Greg Mankiw by way of East Coast Libertarian. More thoughts at Market Power.)