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.

Comments

very good article!

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.

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.

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.

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.

Excellent, excellent, excellent.

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?

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.

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.

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?

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.

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.

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).

Mike:
Alex is not disregarding repugnance, he is simply identifying is as an emotional state and thus reduce (not eliminating) its importance in deciding whether an activity should be made illegal. Maybe the "guilt trip" is a little over-the-top, but given his record on actually presenting ordered arguments and not just expressing opinions his use of emotion to further his already made points is justified, expected and necessary. As for admiration (respect is probably a better word), is it not the arguments or pieces that are admired, it is the persons.

For your part, please provide the audience with some of the reasons that YOU (or others that do) personally find organ markets repugnant and why those reasons justify making those markets illegal IN ALL CASES. While you are doing this consider what assumptions are being made regarding the various values of the pro-comments and the con-comments. Also, ask yourself if you truly appreciate the idea of personal liberty, because any of those values derived in step two ultimately either need to be applied within that context or we need to change our system of government (which is probably more work that it is worth).

So yes, you may have a point for this specific post of Alex's but to take measure of a person from a single post is unfair to the author as well as yourself if you stop reading MR or never actually engage in furthering the conversations.

Mike,

"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?"

Alex is talking about increasing liberty that would largely save lives. People who find this repugnant need to rethink their position because people die unnecessarily.

You are talking about restricting liberty through someone else's idea of what is right. The comparison is a fake. Additionally, there is no clear evidence either way on whether or not gun ownership decreases or increases crime. I write this because people on both sides conjure up statistics that support their side. If the statistics are so bad that both sides come up with statistics to support both sides of an issue and no consensus emerges among the experts, then the truth of the matter is not revealed. So for your little thought experiment, it comes down to ONLY people feeling disgusted at gun ownership and those feeling disgusted at reduced liberty.

In all cases where the statistics don't show any clear evidence one way or the other, I am in favor of choice and liberty. Always and without exception. Unless you can show me a good reason something should be illegal, that activity should remain legal. A good reason would be that society suffers a serious (not minor) loss. And the illegal activities that will pop up once an activity becomes illegal causes less damage than would occur if the activity remain legal. Think of the drug war. Drugs damage society, but having the illegal markets that now exist and the enormous drain on the public treasury to try to enforce the unenforceable damages society more.

In organ markets, the evidence clearly shows an increase in choice and lives saved. The side against organ markets cannot find any reliable statistics supporting the notion that organ markets will not save lives. So in the face of clear evidence, those against the markets use their feelings only, because logic and reason support organ markets.

You present a limp argument. Think a little harder to come up with a good one and get back to me.

Regards,
Ken

David Johnston,

Heart donation is not zero sum. A person could conceivably tie donation of their heart to donation of each of their kidneys and all to 3 different people. So they could die and save 3 lives in the process.

Alex,

Here's my problem with your argument: How do we know when something that is repugnant will remain that way or cease to be repugnant? Maybe you are choosing to change a reaction that is just not amenable to persuasion.

I'm thinking that there are some genetically directed circuits in our brains that affect what we find to be ethically acceptable and that some attempts to reduce the feeling of repugnance are therefore doomed to fail.

Now, maybe such genetic coding exists but does not apply in your case. But is there some way to measure something that will let us know when we are dealing with an issue where people are malleable?

Everyone,

One danger in creating markets for some things is that you then create economic pressures to collect on debts that can pressure people to give up those things. So, for example, an indebted person could be pressured to sell an organ. Creditors are extremely unethical as shown by recent reporting on creditors who do not remove debts from credit reports and who sell those debts to debt collection agencies who harass people even after chapter 11 has been granted.

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?

Absolutely, Tyler.

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...

The possibility that a poor person sells an organ for reasons that make you personally uncomfortable is correctly weighed against the (near) certainty that that exchange saves or considerably improves the life of the person who receives it.

ABC news covered "dollars to donors" last night:
http://abcnews.go.com/Video/playerIndex?id=3889134

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