After reading Augustine’s ‘On the Good of Marriage’ and listening to Dr. Brent Waters wax eloquently on the essay, the question of polygamy in Christianity began to loom. Maybe the topic is currently captivating because of Mitt Romney’s run for President and the anachronistic Mormon polygamy that he engenders, maybe I am fascinated with polygamy because I can barely fathom what monogamy means in society where more than half the marriages end in divorce, maybe I am simply fascinated with it because of a banal and sophomoric interest in the possibility of two wives, and all that might entail… but I digress.
Of all the myriad reasons for interest the real reason is economic.
In Gary Becker’s Treatise on the Family he made an interesting observation about polygamy namely societies that condone polygamy help women and children.
Considering that married women want children (an assumption), women will need resources to support their children and herself. Monogamous societies restrict the supply of possible husbands. As any limited commodity marriageable (monetarily supportive) husbands will be scarce for some women (typically those who are least likely to have qualities to find a spouse). These women may then find themselves making a hard decision: marry the dud who proposed to them, or make it on there own.
If they marry the ‘dud’ they face the possibility of lack of resources to have children or even simply sustain the two-unit family. Further, if they have children they risk not being able to properly provide for them.
If the women choose to live a single life she may have to forgo motherhood in sake of livelihood. Or, as so many women do these days, they have children outside of marriage harrowingly raising the children on their own and on their own salary.
Polygyny – having more than one wife – allows women to have more selection in choosing a husband. Ostensibly this increase in choice will lead to husbands who are better able to support their wives and desired children.
If monogamy falls more in the realm of Christian convention than creed than can the practice of polygyny be acceptable in Christian communities? In most cases the answer will probably be a roaring, ‘No!’ I am sure Christian feminists and moral traditionalists could come up with numerous reasons for why it is a preposterous idea even while conceding that it may, at times, help support destitute women. In the United States the notion could never be entertained, besides nuanced theological, sociological or political arguments (the tax-code would probably have to be augmented, too) it just seems down right un-American. So, perhaps the lasting (yet, still distressed) institution of monogamous marriage is a symbolic vanguard to a culture that is beleaguered by quantitatively squared cost-benefit analyses that seem to forever champion pareto efficiency regardless of the moral costs.
Showing posts with label Economics. Show all posts
Showing posts with label Economics. Show all posts
Wednesday, November 14, 2007
Sunday, September 30, 2007
Selling Kidneys: Part III - Autonomy
Before exploring the ethical issues of autonomy bout up in selling kidneys it should be reminded that:
Part 1 argued that though alternative procurement methods are available all are insufficient in fulfilling the current lack of kidneys, and
Part 2 living, laparoscopic nephrectomies are adequately safe procedures.
The most common concern for vendor procurement models surrounds the obvious fact that most kidney vendors would be poor. Two concerns come to the fore: 1) vendors will not appreciate or understand the health risks associated with the procedure or 2) that payment will “economically coerce” the poor into the surgery out of necessity.
The first concern should be secondary if we assume that any vendor system would necessarily demand lifelong and comprehensive healthcare for vendors, as well, the practice of full disclosure of medical risks for those who agree to be living donors.
Thus the second fear should be centrally considered. It is perhaps the roadblock for the legal consent for the construction of a regulated kidney market. The concern rests in the understanding of autonomy. I submit three reasons for why autonomy is actually upheld, rather than undermined, when vendoring is permitted.
1) Coercion can only be properly rendered as external and intentional.
2) Laws prohibiting the sale of kidneys are paternalistic and inconsistent toward the poor.
3) The dangers associated with kidney transplantations are comparable to other acceptable occupations.
First, autonomy is defined by the absence of coercion. So to ensure that autonomy is upheld it must be shown that a kidney market will not coerce the poor into selling their kidneys. Coercion can be understood in many ways that are intricately catalogued by James Stacey Taylor in his book, Stakes and Kidneys. It should suffice here that coercion must be both external to the individual and intentional. One cannot coercive oneself, thus coercion is, ipso facto, always an external force. Moreover, the agent of coercion must have an intentionality in the action of coercion. Here the situation of poverty is both rested in the individuality of a person’s situation and has not intentional in colluding for control, thus autonomy cannot be limited by one’s economic situation. As Taylor states, “Given that the impoverished person would thus retain full control over their action even as they (desperately) sell a kidney there is nothing in their economic situation that bars them from being fully autonomous with respect to this sale” (53-59).
Also, if autonomy is understood as the ability to choose compared to coercion as the limit of choice then restricting kidney markets actually offer more autonomy because markets offers more choice.
Second, laws that prohibit the sale of kidneys are both paternalistic and inconsistent toward the poor. The issues concerning the poor as the primary population of vendors for market models need not be the case. Requirements for vending could easily stipulate a certain level of personal, yearly income or some similar financial qualification. However, this would lead to blatant paternalism of the poor. Peter Hoyer states, “A paternalistic attitude to [vendors] implied that they are poor, ignorant and endangering their health.” The issue becomes inconsistent when the same federal system that bars kidney sales out of concern for the poor that may be exploited by the medical community also do not offer sufficient options or programs to the poor to increase their standard of living so that they do not, out of desperation, desire to sell a kidney. Robert Vetch makes this point succinctly: markets are only permissible if one, the society has the economic ability to provide the basic necessities for all their citizens and two, if such a country does not ensure such a minimum standard of living. As he states, “If we are a society that deliberately and systematically turns its back on the poor, we must confess our indifference to the poor and life the prohibition on the one means they have to address their problems [lack of financial security] themselves.”
Third, there are comparative dangers found in completely acceptable occupations, which under the same principles should ethically justify kidney markets. Even the highest mortality rate for nephrectomies (.06%) is lower than for other generally accepted occupations, such as commercial fisherman, merchant seaman, tax drivers, construction workers, and those in armed forces. Thus the same principles that allow for the poor to enroll in the armed forces – a statistically dangerous occupation – would also imply consent to a regulated kidney markets, especially considering the fact that the advent of laparoscopic nephrectomies will further lower mortality rates.
Hopefully this post helped to illustrate why autonomy of even poor vendors would not be undermined by regulated kidney markets. However, the ethical issues surrounding beneficence, non-maleficence and equity must still be considered in later posts.
Part 1 argued that though alternative procurement methods are available all are insufficient in fulfilling the current lack of kidneys, and
Part 2 living, laparoscopic nephrectomies are adequately safe procedures.
The most common concern for vendor procurement models surrounds the obvious fact that most kidney vendors would be poor. Two concerns come to the fore: 1) vendors will not appreciate or understand the health risks associated with the procedure or 2) that payment will “economically coerce” the poor into the surgery out of necessity.
The first concern should be secondary if we assume that any vendor system would necessarily demand lifelong and comprehensive healthcare for vendors, as well, the practice of full disclosure of medical risks for those who agree to be living donors.
Thus the second fear should be centrally considered. It is perhaps the roadblock for the legal consent for the construction of a regulated kidney market. The concern rests in the understanding of autonomy. I submit three reasons for why autonomy is actually upheld, rather than undermined, when vendoring is permitted.
1) Coercion can only be properly rendered as external and intentional.
2) Laws prohibiting the sale of kidneys are paternalistic and inconsistent toward the poor.
3) The dangers associated with kidney transplantations are comparable to other acceptable occupations.
First, autonomy is defined by the absence of coercion. So to ensure that autonomy is upheld it must be shown that a kidney market will not coerce the poor into selling their kidneys. Coercion can be understood in many ways that are intricately catalogued by James Stacey Taylor in his book, Stakes and Kidneys. It should suffice here that coercion must be both external to the individual and intentional. One cannot coercive oneself, thus coercion is, ipso facto, always an external force. Moreover, the agent of coercion must have an intentionality in the action of coercion. Here the situation of poverty is both rested in the individuality of a person’s situation and has not intentional in colluding for control, thus autonomy cannot be limited by one’s economic situation. As Taylor states, “Given that the impoverished person would thus retain full control over their action even as they (desperately) sell a kidney there is nothing in their economic situation that bars them from being fully autonomous with respect to this sale” (53-59).
Also, if autonomy is understood as the ability to choose compared to coercion as the limit of choice then restricting kidney markets actually offer more autonomy because markets offers more choice.
Second, laws that prohibit the sale of kidneys are both paternalistic and inconsistent toward the poor. The issues concerning the poor as the primary population of vendors for market models need not be the case. Requirements for vending could easily stipulate a certain level of personal, yearly income or some similar financial qualification. However, this would lead to blatant paternalism of the poor. Peter Hoyer states, “A paternalistic attitude to [vendors] implied that they are poor, ignorant and endangering their health.” The issue becomes inconsistent when the same federal system that bars kidney sales out of concern for the poor that may be exploited by the medical community also do not offer sufficient options or programs to the poor to increase their standard of living so that they do not, out of desperation, desire to sell a kidney. Robert Vetch makes this point succinctly: markets are only permissible if one, the society has the economic ability to provide the basic necessities for all their citizens and two, if such a country does not ensure such a minimum standard of living. As he states, “If we are a society that deliberately and systematically turns its back on the poor, we must confess our indifference to the poor and life the prohibition on the one means they have to address their problems [lack of financial security] themselves.”
Third, there are comparative dangers found in completely acceptable occupations, which under the same principles should ethically justify kidney markets. Even the highest mortality rate for nephrectomies (.06%) is lower than for other generally accepted occupations, such as commercial fisherman, merchant seaman, tax drivers, construction workers, and those in armed forces. Thus the same principles that allow for the poor to enroll in the armed forces – a statistically dangerous occupation – would also imply consent to a regulated kidney markets, especially considering the fact that the advent of laparoscopic nephrectomies will further lower mortality rates.
Hopefully this post helped to illustrate why autonomy of even poor vendors would not be undermined by regulated kidney markets. However, the ethical issues surrounding beneficence, non-maleficence and equity must still be considered in later posts.
Tuesday, August 28, 2007
Should Seminaries Give Atheists Scholarships?
It a strange thing to be sure that in this day of such rampant liberalism such a question is even given a moments ponder – should seminaries subsidize the cost of theological education of avowed atheists? It is an even stranger thing that such things happen – and they do happen.
The repercussions are of course that some hopeful Christians entering seminary are awarded less or even no scholarship monies. This could even lead a possible seminarian to conclude that they are not financially able to attend seminary.
There seem to me a few reasons one might argue for permitting seminaries the possibility in awarding atheists scholarships: 1) a call to diversity, 2) a hope of conversion and 3) a commitment to meritorious awarding.
A Call to Diversity
On one hand, one reason seminaries may justify funding atheists is in the desire to diversify the view and theological perspectives of their students. Brown v. Board of Education fell heavily on the reasoning that there was a psychological and sociological benefit to diversity itself. Theological schools could crassly want diversity for diversity’s sake, or a more refined belief that a plethora of perspectives lead ultimately to better theology. Even the Vatican Councils have a designated ‘devil’s advocate’ that is to play against the prevailing arguments of the day in an attempt to ensure that every conceivable viewpoint is considered.
On the other hand, what theological diversity is needed in the seminary? A denominationally aligned seminary already has an orthodoxy and theological perspective. Certainly, if anything is orthodox in Christian doctrine it is the belief that God exists. Theological education presupposes God’s existence; to ‘do’ theology is already to ‘speak of God.’ So what benefit would it be to have the antithetical perspective introduced in theological classrooms? Further, what assurance would there be that such a ‘token’ atheist would share his or her radically divergent perspective?
I say, there is need for theological diversity in seminaries. A dialogue between the Church, faculty and staff is needed to decide to what degree such diversity should be welcomed; nevertheless, atheists can never properly constitute a ‘theological perspective.’ They are quite literarily ‘a-theist’ in name: they are indifferent to God. Their speech about God is in silence, muted. Thus they can give no proper perspective of God. Their diversity would be a false one.
A Hope for Conversion
On one hand, some might argue that funding an atheist’s theological education could lead them to convert to Christianity. By being steeped in a Christian community, immersed in the history of Christianity and introduced to the Word an atheist would be more likely to be converted to the faith and thus it would be worthwhile to financially support an atheist in attending seminary.
On the other hand, seminary is not the place to convert atheists. Its mission is to primarily train the ministerial leadership of the Church. The monies the seminaries are allocated by patrons are earmarked for this mission, not for conversion and evangelism. Further, the seminary - though obviously a Christian environment - is not necessarily the most effective place to instruct someone on why and how to be a Christian. Thus, it would be both spiritually ineffective and financially improper to use the seminary for such ends.
I say, the seminary is part of the Church and has the same desire to see people turn to the belief in Christ; however it functions different than churches, focusing more on supporting vocations than fostering conversions. This should not be read as an attempt to bar atheists from seminaries who may want to use the institution as an avenue for faith, but rather as a proscription in allocating funds to such individuals for such projects.
A Commitment to Meritorious Awarding
On one hand it may be said that as seminaries are graduate institutions they should reward funding primarily – or perhaps solely – on merit; be it academic, leadership, or relevant experience. Academically, graduate schools must take into account the merit of students entering programs and with financial incentives attract students whom can continue to keep or raise the standard of academic excellence of the school. This also is the case for other meritorious considerations such as past careers and leadership experience. The fact that someone is an atheist need not impinge upon such considerations. Generally, it is the overall strength of the applicant rather than theological convictions that can best be quantified and objectified and thus judged. This both expedites the process while also offering the most reliably way to evaluate students. The financial awarding of scholarship by seminaries need not be different from other graduate schools that primarily if not simply consider the merit of the student while ignoring other such subjective qualities such having such and such political party affiliations or having or not having faith.
On the other hand, seminaries are more than mere graduate schools. It is more an accident than the essence of a seminary. And so, academic excellence, leadership ability and the like are a distant secondary to the most important commitment in the financial determination for seminaries: does the candidate have a viable vocation in leading the Church? Obviously, an atheist cannot answer in the affirmative. Though meritorious considerations should be made to those candidates who can answer positively it must be the first qualification that drives the second. The seminary is not a religious studies department - it is a religious studies department and much more. The seminary should care more about the sanctification of their candidates than their qualifications.
I say that seminaries are not equivalent to other graduate schools; they are qualitatively different, and in following so should the students be qualitatively different. Students that are funded by seminaries should be chosen by qualities that reflect their Christian life; atheists that do no have such a life cannot reflect such qualities.
It seems that though we should not bar atheists from seminaries such institutions should not fund them either. As an atheist who received – and accepted - a full-tuition scholarship and stipend from my institution it seems that perhaps I am making a hypocritical argument; but I do not believe so. I know that I do not believe the seminary should have offered me a scholarship and I am absolutely certain I should not have received such a generous one; however, my argument rested in the fact that I believe seminaries should not offer atheists scholarship, not if I believed it prudent for atheists to accept scholarships from seminaries.
The repercussions are of course that some hopeful Christians entering seminary are awarded less or even no scholarship monies. This could even lead a possible seminarian to conclude that they are not financially able to attend seminary.
There seem to me a few reasons one might argue for permitting seminaries the possibility in awarding atheists scholarships: 1) a call to diversity, 2) a hope of conversion and 3) a commitment to meritorious awarding.
A Call to Diversity
On one hand, one reason seminaries may justify funding atheists is in the desire to diversify the view and theological perspectives of their students. Brown v. Board of Education fell heavily on the reasoning that there was a psychological and sociological benefit to diversity itself. Theological schools could crassly want diversity for diversity’s sake, or a more refined belief that a plethora of perspectives lead ultimately to better theology. Even the Vatican Councils have a designated ‘devil’s advocate’ that is to play against the prevailing arguments of the day in an attempt to ensure that every conceivable viewpoint is considered.
On the other hand, what theological diversity is needed in the seminary? A denominationally aligned seminary already has an orthodoxy and theological perspective. Certainly, if anything is orthodox in Christian doctrine it is the belief that God exists. Theological education presupposes God’s existence; to ‘do’ theology is already to ‘speak of God.’ So what benefit would it be to have the antithetical perspective introduced in theological classrooms? Further, what assurance would there be that such a ‘token’ atheist would share his or her radically divergent perspective?
I say, there is need for theological diversity in seminaries. A dialogue between the Church, faculty and staff is needed to decide to what degree such diversity should be welcomed; nevertheless, atheists can never properly constitute a ‘theological perspective.’ They are quite literarily ‘a-theist’ in name: they are indifferent to God. Their speech about God is in silence, muted. Thus they can give no proper perspective of God. Their diversity would be a false one.
A Hope for Conversion
On one hand, some might argue that funding an atheist’s theological education could lead them to convert to Christianity. By being steeped in a Christian community, immersed in the history of Christianity and introduced to the Word an atheist would be more likely to be converted to the faith and thus it would be worthwhile to financially support an atheist in attending seminary.
On the other hand, seminary is not the place to convert atheists. Its mission is to primarily train the ministerial leadership of the Church. The monies the seminaries are allocated by patrons are earmarked for this mission, not for conversion and evangelism. Further, the seminary - though obviously a Christian environment - is not necessarily the most effective place to instruct someone on why and how to be a Christian. Thus, it would be both spiritually ineffective and financially improper to use the seminary for such ends.
I say, the seminary is part of the Church and has the same desire to see people turn to the belief in Christ; however it functions different than churches, focusing more on supporting vocations than fostering conversions. This should not be read as an attempt to bar atheists from seminaries who may want to use the institution as an avenue for faith, but rather as a proscription in allocating funds to such individuals for such projects.
A Commitment to Meritorious Awarding
On one hand it may be said that as seminaries are graduate institutions they should reward funding primarily – or perhaps solely – on merit; be it academic, leadership, or relevant experience. Academically, graduate schools must take into account the merit of students entering programs and with financial incentives attract students whom can continue to keep or raise the standard of academic excellence of the school. This also is the case for other meritorious considerations such as past careers and leadership experience. The fact that someone is an atheist need not impinge upon such considerations. Generally, it is the overall strength of the applicant rather than theological convictions that can best be quantified and objectified and thus judged. This both expedites the process while also offering the most reliably way to evaluate students. The financial awarding of scholarship by seminaries need not be different from other graduate schools that primarily if not simply consider the merit of the student while ignoring other such subjective qualities such having such and such political party affiliations or having or not having faith.
On the other hand, seminaries are more than mere graduate schools. It is more an accident than the essence of a seminary. And so, academic excellence, leadership ability and the like are a distant secondary to the most important commitment in the financial determination for seminaries: does the candidate have a viable vocation in leading the Church? Obviously, an atheist cannot answer in the affirmative. Though meritorious considerations should be made to those candidates who can answer positively it must be the first qualification that drives the second. The seminary is not a religious studies department - it is a religious studies department and much more. The seminary should care more about the sanctification of their candidates than their qualifications.
I say that seminaries are not equivalent to other graduate schools; they are qualitatively different, and in following so should the students be qualitatively different. Students that are funded by seminaries should be chosen by qualities that reflect their Christian life; atheists that do no have such a life cannot reflect such qualities.
It seems that though we should not bar atheists from seminaries such institutions should not fund them either. As an atheist who received – and accepted - a full-tuition scholarship and stipend from my institution it seems that perhaps I am making a hypocritical argument; but I do not believe so. I know that I do not believe the seminary should have offered me a scholarship and I am absolutely certain I should not have received such a generous one; however, my argument rested in the fact that I believe seminaries should not offer atheists scholarship, not if I believed it prudent for atheists to accept scholarships from seminaries.
Sunday, August 26, 2007
Selling Kidneys: Part II - Living Kidney Tx
We should agree that cadaveric donations cannot fully satiate the demand for kidneys (see Part I).
In a desire to explore all viable medical and ethical options to increase the number of kidney transplantation one should then turn to living kidney transplantations.
Surprisingly living transplantations came before cadaveric transplantations, usually between twins when immunosuppressant drugs were still only marginally effective or inexistent. For a while cadaveric donation (CD) became much more common then living donations (LD), but through the 1990's LD become an accepted medical procedure between family members or related living donors (RLD). Following this, emotionally-related living donations become acceptable. Thus, between 2001-2003 there were more LD than CD txs (See OPTN database). Though now there is an almost equal number between living and cadaveric donations.
Moreover, LD are usually preferable to CD txs because LD can be done preemptively, before a patient begins to undergo dialysis. This noticeably decreases the morbidity and mortality rates of the recipients who were pre-emptive. Further, the longer a patient is on dialysis the less effective the kidney transplantation will be in improving the quality and quantity of life.
Of course, during this time the LD operation (nephrectomy) became much safer, less invasive, and offered a quicker and less painful recovery time for the patient. Two reasons for this: 1) growing experience in the field from doctors who began to specialize in the procedure and 2) laparoscopic technology that bypassed the need for opening the abdominal cavity of the donating patient.
The procedure has become so safe that most hospitals now allow for non-direct donations or sometimes called 'good-Samaritan' donations. This is when the donor does not know the recipient. This is the type of donation I went through (see Donating a Kidney).
To say anecdotally that the procedure is safe does not likely reassure the modernist mind. So, cautiously and pessimistically the surgical mortality (death) rate is around <.005% or death in 1 in 20,000 cases. The chance of complication during surgery or the morbidity rate is a little higher, around <.007% (See OPTN).
It seems that this 'minor major' surgery is a relatively safe procedure. Living transplantations then might be a viable means to procuring more kidneys. The next post will then begin to look at the ethics surrounding living kidney procurement options – most specifically at direct financial incentive options.
Post Script
I want to thank my friend and blog-resident surgeon Jessica Clevenger for making sure I am not spoofing on any medical facts or jargon. Thank you.
In a desire to explore all viable medical and ethical options to increase the number of kidney transplantation one should then turn to living kidney transplantations.
Surprisingly living transplantations came before cadaveric transplantations, usually between twins when immunosuppressant drugs were still only marginally effective or inexistent. For a while cadaveric donation (CD) became much more common then living donations (LD), but through the 1990's LD become an accepted medical procedure between family members or related living donors (RLD). Following this, emotionally-related living donations become acceptable. Thus, between 2001-2003 there were more LD than CD txs (See OPTN database). Though now there is an almost equal number between living and cadaveric donations.
Moreover, LD are usually preferable to CD txs because LD can be done preemptively, before a patient begins to undergo dialysis. This noticeably decreases the morbidity and mortality rates of the recipients who were pre-emptive. Further, the longer a patient is on dialysis the less effective the kidney transplantation will be in improving the quality and quantity of life.
Of course, during this time the LD operation (nephrectomy) became much safer, less invasive, and offered a quicker and less painful recovery time for the patient. Two reasons for this: 1) growing experience in the field from doctors who began to specialize in the procedure and 2) laparoscopic technology that bypassed the need for opening the abdominal cavity of the donating patient.
The procedure has become so safe that most hospitals now allow for non-direct donations or sometimes called 'good-Samaritan' donations. This is when the donor does not know the recipient. This is the type of donation I went through (see Donating a Kidney).
To say anecdotally that the procedure is safe does not likely reassure the modernist mind. So, cautiously and pessimistically the surgical mortality (death) rate is around <.005% or death in 1 in 20,000 cases. The chance of complication during surgery or the morbidity rate is a little higher, around <.007% (See OPTN).
It seems that this 'minor major' surgery is a relatively safe procedure. Living transplantations then might be a viable means to procuring more kidneys. The next post will then begin to look at the ethics surrounding living kidney procurement options – most specifically at direct financial incentive options.
Post Script
I want to thank my friend and blog-resident surgeon Jessica Clevenger for making sure I am not spoofing on any medical facts or jargon. Thank you.
Thursday, August 23, 2007
Selling Kidneys: Part I - Cadaveric Options
End-Stage Renal Disease (ESRD) has only two viable medical options to date: regular dialysis or kidney retransplantation. Dialysis is more expensive, less effective and limits certain lifestyles choices. Transplants, then, are a superior option to handling ESRD, but as it has already been said there is a severe shortage of kidneys. So three questions come to the fore: 1) What might increase the supply of kidneys? 2) Will that option be ethical? 3) Will that option be effective?
What might increase the supply of kidneys?
The good news is that there are a surprising number and a variety of ways to increase the number of transplantable kidneys. The bad news is that many of them are either questionably ethical or marginally effective or both.
One broad way to increase the kidney supply is to increase the number of cadaveric organ donations. Currently this country runs under an 'opt-in' system for cadaveric organ donation. In contrast Belgium, inter alia, runs on a 'opt-out' model, where everyone is presumed to be an organ donor unless they choose specifically and explicitly to not participate. Also, though no country is currently under a 'salvage' model it has been discussed by ethicists. Here citizen preference is completely disregarded - essentially the state has ownership of the body of deceased citizens for medical purposes: organ donation conscription. Of course, this final model has obvious ethical dilemmas.
There are two options with both ethical and effective promise.
1) Offer a 'required response' model. This is the blend between the 'opt-in' and 'opt-out' models. It would require citizens to make choice between being or not being an organ donor - most likely it would manifest as a question on yearly IRS tax forms. Polls have suggested that many people want or are willing to be organ donors, but have been deterred in the process to 'opt-in.' The hopes of this method would be to reduce the possible deterrence in becoming a organ donor, which is currently done through the DMV while registering/updating licenses. The downside of the model is that on its own it does introduce an incentive for donating.
2) The government offers a non-direct pecuniary incentive for those willing to be organ donors. This incentive could take many forms. Mostly likely it would be some type of premium reduction in the cost of health insurance (subsidized by the government or run through medicare), a one-time tax reduction, or subsidizing funeral costs. This would almost surely increase the number of donors, but there are ethical qualms about the introduction of any form of pecuniary incentives (this will be discussed at length - perhaps even ad nauseam - in future posts).
Both of these options are ethically innocuous enough to be at least conceivable options in the United States. However, the fact is they just won't be able to satiate the need for kidneys. (Though these measures should still be seriously considered because of the inability to do living transplantations on other organs, most poignantly hearts.
Even if some financial incentive is introduced to increase the number of citizens to enroll as organ donors it will not be able to adequately reduce the number of patients on the kidney waiting-list. Even if everyone was a donor there would likely still be need for kidneys because so few people die in a way compatible with donating.
So, while cadaveric options to increase the supply of organs may be a worthwhile venture, it will not be suitable to address the shortage for kidneys. That is why living kidney transplantations must be considered. In the next post I will address the medical issues surrounding living donation (LD) and what incentives might be introduced to increase such operations.
What might increase the supply of kidneys?
The good news is that there are a surprising number and a variety of ways to increase the number of transplantable kidneys. The bad news is that many of them are either questionably ethical or marginally effective or both.
One broad way to increase the kidney supply is to increase the number of cadaveric organ donations. Currently this country runs under an 'opt-in' system for cadaveric organ donation. In contrast Belgium, inter alia, runs on a 'opt-out' model, where everyone is presumed to be an organ donor unless they choose specifically and explicitly to not participate. Also, though no country is currently under a 'salvage' model it has been discussed by ethicists. Here citizen preference is completely disregarded - essentially the state has ownership of the body of deceased citizens for medical purposes: organ donation conscription. Of course, this final model has obvious ethical dilemmas.
There are two options with both ethical and effective promise.
1) Offer a 'required response' model. This is the blend between the 'opt-in' and 'opt-out' models. It would require citizens to make choice between being or not being an organ donor - most likely it would manifest as a question on yearly IRS tax forms. Polls have suggested that many people want or are willing to be organ donors, but have been deterred in the process to 'opt-in.' The hopes of this method would be to reduce the possible deterrence in becoming a organ donor, which is currently done through the DMV while registering/updating licenses. The downside of the model is that on its own it does introduce an incentive for donating.
2) The government offers a non-direct pecuniary incentive for those willing to be organ donors. This incentive could take many forms. Mostly likely it would be some type of premium reduction in the cost of health insurance (subsidized by the government or run through medicare), a one-time tax reduction, or subsidizing funeral costs. This would almost surely increase the number of donors, but there are ethical qualms about the introduction of any form of pecuniary incentives (this will be discussed at length - perhaps even ad nauseam - in future posts).
Both of these options are ethically innocuous enough to be at least conceivable options in the United States. However, the fact is they just won't be able to satiate the need for kidneys. (Though these measures should still be seriously considered because of the inability to do living transplantations on other organs, most poignantly hearts.
Even if some financial incentive is introduced to increase the number of citizens to enroll as organ donors it will not be able to adequately reduce the number of patients on the kidney waiting-list. Even if everyone was a donor there would likely still be need for kidneys because so few people die in a way compatible with donating.
So, while cadaveric options to increase the supply of organs may be a worthwhile venture, it will not be suitable to address the shortage for kidneys. That is why living kidney transplantations must be considered. In the next post I will address the medical issues surrounding living donation (LD) and what incentives might be introduced to increase such operations.
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