Legalization of Some Beneficial Black Markets Are Needed
More than a year ago when I was solo backpacking through central China, I argued that the illegal underground markets for imitation products provide an economic way for increase material consumption and employment of relatively poor areas. But the argument back then was still much too deviated from the legal reality to make much of a difference. After all, the value of expensive brands exist because of high quality and restricted supply, both of which are undoubtedly disturbed by the very existence of such markets for imitation goods.
And people have the perfectly legal alternative to buy cheaper, non-branded, legally produced goods serving the exact same functions. The closure of the imitation market should not fundamentally reduce the standard of living for their consumers. The illegal markets fulfilled a "want" (most likely for "face" and bragging of the consumers to fulfill a standard Asian mental desire to out-compete others in everything) rather than any substantial need in which the consumers will be hurt if the exact same goods cannot be bought.
But what if the illegally sold goods are somehow vitally for the very survival of the consumers they are targeting? Then, does morality contradict what is legally considered correct thing to do? The perfect instance to consider the question is organ trafficking. In most countries of the world, the US included, the trading of organ, even when voluntary, is prohibited by law. The law stipulates that any organs used for transplant must come from voluntary donations without any involvement of money.
Yet, as it is the case everywhere, the demand for organ transplant from an ever-increasing waiting list of gravely ill patients constantly outstrip the supply of voluntarily donated organs. The discrepancy no doubt lead to the situation in which some of the well-off people on the waiting list are willing to pay high prices for a needed organ. And there are plenty of poor people out there with perfectly healthy organs willing to trade them in for some much-needed cash. It is not like people need EVERY organ they are given biologically for survival.
People tend to argue that such black market should not be allowed to exist because it is biased in favor of the wealthy. Only the wealthy can afford to buy organs, and the seriousness of the need is not considered part of the process. Certainly, it is unfair that only wealthy people can use the black market to obtain organs, but if the wealthy can pay their way off the waiting list for voluntarily donated ones, which indeed is listed by the seriousness of the patients, then, isn't the existence of the organ-trading market also benefit the poor?
The answer should be a legalization of both the waiting list for voluntary donations and the market for sold organs. By crossing off the wealthy serious patients on the top of the waiting list, the poor can also get a better chance of securing a needed organ without hefty fees. The need for organs can translate to an economic trickle-down effect in which people with healthy organs, often selling in poorer countries, can increase their income, consumption, and contribution to development of their regional economies.
The only issue, as many people pointed out, is how to prevent a dwindling of voluntary donations due to legalization of trading. It certainly makes no sense for people to donate for free when they can earn some extra cash from doing the same thing. Yet, the same people fail to realize that with a legal global market for organ trading established, the increase in supply will certainly drive down the cost. With further government regulation, it is not hard to see the possibility of organs becoming affordable for most middle class families across the world.
As technologies develop, the idea of organ trading, as well as many other goods now sold in black markets, will no doubt become obsolete. But in the meantime, it would be rational to ask lawmakers to consider a proposal that is both life-saving and economically beneficial for the most needy. The legalization of black markets for such vital goods, if correctly regulated and monitored by proper authorities, can only lead to benefits.
And people have the perfectly legal alternative to buy cheaper, non-branded, legally produced goods serving the exact same functions. The closure of the imitation market should not fundamentally reduce the standard of living for their consumers. The illegal markets fulfilled a "want" (most likely for "face" and bragging of the consumers to fulfill a standard Asian mental desire to out-compete others in everything) rather than any substantial need in which the consumers will be hurt if the exact same goods cannot be bought.
But what if the illegally sold goods are somehow vitally for the very survival of the consumers they are targeting? Then, does morality contradict what is legally considered correct thing to do? The perfect instance to consider the question is organ trafficking. In most countries of the world, the US included, the trading of organ, even when voluntary, is prohibited by law. The law stipulates that any organs used for transplant must come from voluntary donations without any involvement of money.
Yet, as it is the case everywhere, the demand for organ transplant from an ever-increasing waiting list of gravely ill patients constantly outstrip the supply of voluntarily donated organs. The discrepancy no doubt lead to the situation in which some of the well-off people on the waiting list are willing to pay high prices for a needed organ. And there are plenty of poor people out there with perfectly healthy organs willing to trade them in for some much-needed cash. It is not like people need EVERY organ they are given biologically for survival.
People tend to argue that such black market should not be allowed to exist because it is biased in favor of the wealthy. Only the wealthy can afford to buy organs, and the seriousness of the need is not considered part of the process. Certainly, it is unfair that only wealthy people can use the black market to obtain organs, but if the wealthy can pay their way off the waiting list for voluntarily donated ones, which indeed is listed by the seriousness of the patients, then, isn't the existence of the organ-trading market also benefit the poor?
The answer should be a legalization of both the waiting list for voluntary donations and the market for sold organs. By crossing off the wealthy serious patients on the top of the waiting list, the poor can also get a better chance of securing a needed organ without hefty fees. The need for organs can translate to an economic trickle-down effect in which people with healthy organs, often selling in poorer countries, can increase their income, consumption, and contribution to development of their regional economies.
The only issue, as many people pointed out, is how to prevent a dwindling of voluntary donations due to legalization of trading. It certainly makes no sense for people to donate for free when they can earn some extra cash from doing the same thing. Yet, the same people fail to realize that with a legal global market for organ trading established, the increase in supply will certainly drive down the cost. With further government regulation, it is not hard to see the possibility of organs becoming affordable for most middle class families across the world.
As technologies develop, the idea of organ trading, as well as many other goods now sold in black markets, will no doubt become obsolete. But in the meantime, it would be rational to ask lawmakers to consider a proposal that is both life-saving and economically beneficial for the most needy. The legalization of black markets for such vital goods, if correctly regulated and monitored by proper authorities, can only lead to benefits.
I think... that would be a bioethicist's nightmare. some additional things to think about:
ReplyDelete1. some people claim that it is unfair that rich people can afford organs when poor can't. This is true...
But who would sell their organs? People who would need money. This is established in your essay. Is it fair that it will be the poorer people who will sell their organs? A middle class or upper class person will most likely not sell their organs. Sure, we can claim the poor are getting financial benefit.... but does that benefit outweigh the loss of something as intimate as your own body part? If it is only the poor selling their organs, isn't it true that we are still taking advantage of them (regardless of any financial compensation)?
2. "It is not like people need EVERY organ they are given biologically for survival."
Such as? Most organs that have waiting lists are for those that are non-regenerative (like pancreas, kidney, etc...) and not regenerative ones (like blood)I'd say the majority of organs require it to be harvested from deceased people. I don't know too much about transplantation but I can only think of kidneys and liver (the liver is capable of regenerating itself....slowly). I suppose you COULD donate your eyes and still live... but why would you want to do that?
Even organs like kidneys (we have two of them)... if I donate a kidney, I would have one left. Which is still okay because the body will adapt. But what happens if something goes wrong with that one kidney i have, be it a tumor or a car accident that severely damages the kidney? I'll need another kidney.
Going back to Point 1, I think only the poorer people would donate their organs. Is it fair that poorer people will have to increase their risk of future problems just because they sold organs to earn some cash? Is a one-time payment of $20k, 40k, or even $1 million REALLY a fair compensation? And....If opening the organ market will lower prices, won't that still screw over the poor people in the long run?
3. there could potentially be a rise in illegal means of procuring organs as well. You already have people, especially in poorer areas, who are willing to sell of their children or relatives for sex trafficking in order to get money. Won't people be willing to force people to sell organs then to get money? Or how about a rise in criminal organizations that may kidnap people in order to procure and sell organs?
Just food for thought!
Thanks for the reply as always!
ReplyDeleteThe questions that you asked in (1) are exactly those that the poor will be contemplating as they go about making the decision on whether or not to sell their organs...and unfortunately (or fortunately), they certainly answered that the money is worth more than the body part, and that it is ok for them to be taken advantage of financially if they can get the cash...in a desperate situation, I think they would simply be happy to get another legal way of earning cash...
As for (2), I think this is where certain degree of proper monitoring is required. There need to be professionals at proper, legally registered organ-trading institutions who can inform the organ sellers of the potential hazards. There are side effects to everything, just look at the fine printing on prescription medicines...sometimes it pretty much says "you might die if you take this drug" but those drugs still sell...at the end, it all comes down to whether the individual is willing to take the risks...
And for (3), I think proper regulation will definitely help out. Organ-trading clinics will have to properly registered with the government and any hospital performing organ transplants will have to buy only from these legally registered clinics. If we are to make these clinics non-profit entities, the economic rationale for continued existence of an organ-trading black market should not exist...there would simply be no way that illegal traffickers can make money underselling the legal clinics....
The ethics behind the organ-trading, I think, is not particularly different from the one behind prostitution. There will always be someone willing to give up something precious and take some risks for cash, and the market for the service is pretty much guaranteed. The key for proper operation of such an arrangement, at the end, should be regulation and monitoring, not morals and ethics...
Disagree with your reply to point (1). poorer people will often have less education... i'm not saying they are incapable of making such decisions... but I'm not sure poor people will necessarily think about it. Plus, if they are truly that poor, they may feel as if they have any other choice but to sell... Think about just how desperate people have to be if they are to sell their daughters into sex trafficking rings..... Short term gain usually trumps long term caution....
ReplyDeleteAs a segway into (2), education is not as easy as it seems. Having worked with lower-class, lesser-educated people in the Baltimore healthcare system.... education can be extremely difficult. Many people in Baltimore City don't know how to practice safe sex for instance (even knowing how to put on condoms and such). In third world countries, one of the big controversial issues was the marketing of baby formula.... the locals, despite being really poor, believed it was superior to breast milk and bought it, despite the high cost. to save money, they then diluted the formula and gave to babies, who would suffer from malnutrition. even with public service announcements, changing that belief system was hard. Or even think about public health campaigns targeted at educated, rich people such as exercizing daily and eating a well-balanced meal! How many people actually listen to that stuff?
It's also different with prescription drugs... Those are usually administered upon a doctor's recommendation. It is not the patient who researches it and buys it. And usually the doctor has the patient's best interest in mind. There is no financial interest on the part of the patient to take or refuse the treatment. It's very different than giving up a body part. It's a different sort of risk. And the educator cannot recommend to a person whether or not to give up a body part.... that would be unethical.
Not sure if i would totally buy into "The key for proper operation of such an arrangement, at the end, should be regulation and monitoring, not morals and ethics..." as well. Take a look at Wall Street. There's regulation and monitoring but we still had major problems because of a lack of ethics and morals. Even if you were to say that that was because more regulation and monitoring was needed... at what point does it become okay? Is having Big Brother a better alternative to lack of morals and ethics? Better yet, aren't the reasoning and thoughts behind regulations and monitorings based upon morals and ethics?
hmmm...I totally agree with the point on " if they are truly that poor, they may feel as if they have any other choice but to sell... " but I am not sure if they are any effective method out there that will prevent these people from actually selling their organs...I mean, if some guy walk up to a bum and says, "I will give you 20,000 bucks upfront for one of your eyes," I feel that some bums will actually say yes...
ReplyDeleteSo the best way for people to help them is not to go after the elusive buyers of the bums' eyes, but to provide a safe environment for the bum to make some cash on his eye, without threat of post-surgical infections or getting cheated out of his 20,000 bucks. Only that way will the illegal buyers disappear because the black market will collapse.
And for poor people selling their daughters into sex traffickers, the same logic works. You cannot completely stamp out the market by going around arresting what traffickers you can actually catch. Instead, as unethical as this may sound, maybe it is better to formulate a system in which people seeking adoption can pay for these unwanted daughters through adoption agencies...
Of course, this sort of system would create a whole new set of problems (some poor people will start irresponsibly having large number of kids just for money), but at least we can live with the fact that under such economic arrangement, it is much more likely for the girls to end up in a functional family rather than selling their bodies...
And you are definitely right on the regulations. There certainly is no end to regulations when people start applying them, because there will always be a certain political segment arguing how existing regulations are not enough. But the only alternative to regulation is education. And you already mentioned how difficult it is to educate people, especially in the poorest segments of the society. While we are busy educating for their long-term benefits, I would not be surprised if they already sold a few organs and kids in the meantime...
And if the whole fiasco in Wall Street has taught us anything, it is that it is impossible to teach certain people morals and ethics when having completely no morals and ethics means making A LOT of money that can pretty much be used to rid themselves of legal responsibilities when stuff goes wrong. These people in Wall Street have no problem sleeping at night knowing lives of so many people across the world are ruined by their greediness. As long as they can still profit from the process, I have to be pessimistic and say they will not change no matter how much moral and ethics the rest of us try to instill in them....
Wouldn't it be better to figure out a way to help the bum live better instead of having the bum "safely" donate an organ?
ReplyDeleteSome more thoughts to consider:
Even if we were to completely legalize organ selling, I don't know if it will help the problem of the lack of organs. People express different proteins on their organs and such and you need a good match to avoid immediate rejection of the organ (the body will attack the organ as if it were a virus or bacteria). even with a strong match, the patient will be put on immunosuppressive drugs to prevent rejection. And even so, the chance of the organ failing is pretty high after 5-10 years. After that organ fails, you'll need to find another organ. The 10 year success rate ranges between 20-50% depending on the organ. A 2nd transplant also has more complications to consider (ie the formation of certain antibodies), further dwindling your available supply of organs. So even if we had a organ supermarket, you would have to find a match before you can use it... Not an easy proposition.... Even with a free market system.
So I would assume that the availability of organs to a recipient is not only affected by supply issues, but also biological issues. There is a lot of variability of proteins and factors on organs.... So much so that you would need to have a huge huge huge bank of organs to find the right match for a given person... Something that I don't know would still happen if we opened up the market.....
Take blood for example... We essentially need to look for one thing... If the blood expresses the A, B, AB, or no(O) proteins. In organs, we look at 6 main things(even though there are many more things to look for). Having a match at 3 of the 6 is considered good but not ideal....
Opening up the market will probably not be the cure-all for this problem. At least that is my opinion haha
Here are some other issues to think about as well:
- if we can purchase organs, would it be ok to have say an alcoholic get a liver transplant? Especially if they will continue their drinking behavior? Even if they I'll pay for it? (think say a millionaire drug addict)
 - what constitutes a "worthy" patient? Someone who can pay for the organ? If it's that, aren't we giving preferences to the rich? Or if we pick the sickest person.... Will they be too sick to have any benefit?
Currently, there is research into making genetically altered organs from pig sources. This might have the most potential, though we a far from having a perfect working model just yet. But there's been a lot of progress here....
Well, it again goes back to your point on how educating people just takes way too long...some people are simply just too impatient to "learn" and find out some "legitimate" way of making money...they prefer the quick buck and perhaps will go out of their way to fulfill their financial need in the short term...
ReplyDeleteThe point about biological rejection of received organs is a good point...I really cannot argue with that except the fact that more organs means more chances of finding that perfect match, no matter how difficult it is....
As for wealthy drug addict getting an organ, my answer is "YES"...if the guy is a drug addict and still managed to not completely squander his inheritance, I suppose he is still doing a decent enough job to deserve a chance to continue living and paying taxes haha
And as for poor people getting organs in the organ-trading market, I think a good analogy may be college. Certainly there are plenty of poor people with great potential out there who would never be able to go to Harvard if it werent for scholarships...may be some sort of "scholarship system" should be established for poor patients with great potentials so they can afford organ transplants?
well, if it becomes a purely ethics issue,
ReplyDeletethen I think the current system of assigning "priority list" for organ transplant is not particularly well-designed either...
I mean, seriously, you can use the two people you used in the example to the question of "who gets to be higher on the list" and still make your head hurt...the bottom line is that, ultimately, there has to be somebody or some institution being the supreme, unquestioned judge of ethics in organ transplant...and as of now, the public sure does not have much of a say in anything...
One thing, though, if a rich guy is rich for a productive reason,
and a completely law-abiding citizen (other than drugs and alcohol and all), then wouldnt keeping the rich be beneficial for ALL (theoretically) since their being alive guarantees higher tax revenue for the govt?
"I really cannot argue with that except the fact that more organs means more chances of finding that perfect match, no matter how difficult it is.... "
ReplyDeleteTrue... but i think you'll never achieve the low costs you claim because demand will be higher than supply regardless due to the biological complexities. :)
But... going back to the ethics...Let's make this more interesting. Suppose there are two people.... the aforementioned rich alcoholic and a normal (in terms of wealth) person. They both need the same organ and are both matches for one. There is only one such organ available.
1. Who gets it?
2. Should the rich man get the organ because he can pay for it?
3. What if the rich person was 70 years old and the normal was 20?
4. What if the rich person is a single playboy and the normal has a family of 5 and is the sole breadwinner of the family?
5. Or instead of being a family man, what if the normal person is a repeat sex offender?
6. What if the rich, 70 year old man is a repeat sex offender?
Head hurt yet?(I actually don't have an answer... lol... just for thought... just saying that even as is, the ethics behind organ transplant is pretty convoluted :P )As for your analogy... i dont think it holds. Education and life are two different things. Giving "scholarships" to essentially determine who lives and who doesnt.... it doesn't really sit well with me. :P But suppose we did have that scholarship. what would be the criterias? if we are solely looking at income, what if the scholarship is available for people who make under $x dollars a year. What about people who are slightly above the cutoff but not high enough to afford the treatment by itself? (This is essentially a problem with Medicaid right now for what its worth).