Freedom of choice

[Edric O]

While browsing rather aimlessly around the web last night, I came upon a libertarian blog whose author had recently made a post fiercely advocating the legalization (and deregulation) of selling one's organs. The argument he put forward can essentially be boiled down to the following: A person wishing to sell an organ - for example, a kidney - must be in a desperate situation. You would only choose to sell an organ if you considered the alternative(s) to be worse; for instance, if you had a choice between selling a kidney and starving to death. Thus, the libertarian claims, since a person would only choose to sell their organs if this was the best (or least bad) alternative available to them, it follows that no harm can come from creating a legal organ market. On the contrary, it would help some of the poor by giving them the option of selling a kidney rather than starving.

This is an extreme example of the broader liberal* view on freedom of choice: In any situation, if given a number of choices, a person will always choose the option they consider to be best. Thus, only good can ever come from giving people more choices. If the new choices are worse than previously existing ones, people will not choose them and nothing will change. If the new choices are better than previously existing ones, people will take advantage of them to improve their well-being. Most importantly, liberals believe that the value of each choice is subjective: different people have different preferences, such that one man's best choice is another man's worst, and vice versa.

Unfortunately, as with most liberal ideas, this one assumes that individuals live in a vacuum, that they are completely unaffected by social pressures and that their initial situation is a given which cannot be changed. In addition, the concept that the value of each choice is subjective and that no option is inherently better than another leads the liberal to conclude that the number of choices is the only thing that matters. This extreme form of relativism can produce some very inhumane results.

While it is true that most individuals will tend to choose the best option among those given to them, the catchphrase here is "among those given to them". Freedom of choice means little if all the choices you have are bad. You will choose the lesser evil, of course, but it may still be quite evil. The liberal outlook cares only for the number of choices with no regard for the quality of choices, because liberals believe quality to be inherently relative and dependent on each individual's preferences. But if a man sentenced to death is given a choice between being hanged, shot, drowned, or a thousand other methods of execution, I doubt he will be particularly thankful for his wonderful freedom to choose. He would much rather have just two choices, along the lines of "get shot or go free". The choice "go free" is far superior in quality to a thousand choices between different methods of execution. In matters of freedom of choice, quality trumps quantity. And the quality of choices, despite liberal claims to the contrary, is often objective rather than subjective.

The narrow liberal focus on the quantity of choices leads liberals to proclaim every new choice - no matter how bad - as an increase in freedom. Thus, the man who has a choice between starving and selling a kidney is more "free" (in the liberal sense) than the man who simply has to starve.

The socialist outlook, on the other hand, focuses on the intrinsic quality of choices. In addition, socialists look beyond the unrealistic case of a single isolated individual and take into account the social consequences of every action or policy. Selling a kidney to feed yourself isn't much better than starving (especially since you'll end up starving anyway if nothing changes in your financial situation). Thus the legalization of organ selling would not do much good at all. On the contrary, it may in fact cause great harm through its social effects. Increasing numbers of people in desperate situations would resort to selling their organs to keep themselves alive. The fact that selling a kidney is a relatively simple and quick way of getting a large sum of money would cause many of the poor to turn to this solution instead of options that demand greater effort and promise a lower income spread out over a longer period of time. In brief, the organ business would carve out a market for itself and destroy innumerable lives in the process.

Finally, and perhaps most importantly, socialists ask a question that never occurs to liberals. Namely, "how did people end up in such desperate poverty in the first place?" Liberals consider the initial situation (in this case, poverty) as a given. And then they look to the number of choices available to people in that situation. Socialists look the quality of the choices instead - and, at the same time, try to understand what caused the initial situation and what can be done about it.

Thus, the fundamental difference between the liberal and the socialist can be summed up in the questions they would ask when faced with a starving man who is prohibited from selling a kidney to buy bread. The liberal will ask, "why don't you allow the man to sell his kidney?" The socialist will ask, "why is that man on the brink of starvation in the first place?"

* Note: I refuse to use American definitions of the terms "liberal" and "conservative". They only cause confusion.

[Dante]

Does it matter? The fact of the matter is that someone is starving, and social changes are far too slow to make any significant impact before they die. The little cash gained from selling an organ or two may be just enough to keep someone alive until either their situation is improved for them or they manage to do it themselves. And if the procedure were performed in proper hospitals then there would be a greater guarantee of survival, and also the organ in question could then be donated (to someone else) very quickly.

Accepting poverty as a given doesn't seem such a crazy idea. It's here, it has always been here. It doesn't show any signs of disappearing.

Even assuming that poverty will eventually be no more, I don't see the harm in introducing temporary legislation to allow selling organs until that time.

I'm actually considering Lord Vetinari's philosophy regarding crime. There will always be crime, so it might as well be government regulated in order to turn a profit. Or something like that. Justification for the Thieve's Guild. So, why not apply that elsewhere? Government regulation of drugs, of organ selling, of thieft, of murder, of smuggling... I'm not entirely sure whether I'm being serious or not. Will have to think about it some more.

[VigilVirus]

Murder tax.

[Edric O]

Does it matter? The fact of the matter is that someone is starving, and social changes are far too slow to make any significant impact before they die. The little cash gained from selling an organ or two may be just enough to keep someone alive until either their situation is improved for them or they manage to do it themselves.

The problem is that the little good done to one individual by allowing him to sell his organs to survive is greatly outweighed by the negative social changes produced by the legalization of organ selling. In brief, as I explained, the organ market will grow at the expense of other markets that could provide better options for the poor, such as the market for unskilled labor. More people will sell their organs and less people will look for other ways out of poverty. Also, you have to consider the psychological effects: a culture may develop in which the poor are expected to sell their organs. Welcome to dehumanization.

Accepting poverty as a given doesn't seem such a crazy idea. It's here, it has always been here. It doesn't show any signs of disappearing.

Do I need to write a list of all the things that "have always been here" until they were eliminated in the 20th century? Smallpox, high infant mortality in the West, European wars... Besides, poverty, like all those things, isn't just a yes/no question. It's a question of degree: How many people are poor and how bad is their poverty. Of course it's extremely unlikely that poverty will ever be completely eradicated, but it is possible to greatly reduce it - so that no one is in danger of starving, for example.

Even assuming that poverty will eventually be no more, I don't see the harm in introducing temporary legislation to allow selling organs until that time.

The temporary legislation makes matters worse by perpetuating poverty and dehumanizing the poor.

I'm actually considering Lord Vetinari's philosophy regarding crime. There will always be crime, so it might as well be government regulated in order to turn a profit. Or something like that. Justification for the Thieve's Guild. So, why not apply that elsewhere? Government regulation of drugs, of organ selling, of thieft, of murder, of smuggling... I'm not entirely sure whether I'm being serious or not. Will have to think about it some more.

That would lead to social collapse. If people know that the government will not protect them from theft and murder, they will (a) start defending themselves by any means necessary, and (b) become thieves and murderers themselves. The government would lose all legitimacy in the eyes of the public. You have to keep in mind that the only reason the government is able to exist in the first place is because most people obey its laws voluntarily. There is a limited amount of disobedience that any government can deal with. Peaceful civil disobedience by a large minority (not even a majority) of the population is enough to bring down most governments. Violent disobedience by a majority would lead to complete social collapse in a matter of days or weeks.

If violence is legalized, it generates a feedback loop: The only way to defend yourself from armed gangs and Thieves' Guilds would be to set up your own armed gang. Thus the number of armed gangs would grow until society as we know it no longer exists.

[Dante]

The problem is that the little good done to one individual by allowing him to sell his organs to survive is greatly outweighed by the negative social changes produced by the legalization of organ selling. In brief, as I explained, the organ market will grow at the expense of other markets that could provide better options for the poor, such as the market for unskilled labor. More people will sell their organs and less people will look for other ways out of poverty. Also, you have to consider the psychological effects: a culture may develop in which the poor are expected to sell their organs. Welcome to dehumanization.

Dehumanisation is easy enough anyway. And furthermore, there are only a limited number of organs that people can sell. One kidney, a bit of liver, perhaps some gut and if desperate a lung. After a while you run out of bits to sell, and turn to other methods of getting cash. The organ industry would certainly grow, but the very nature of the stuff makes a monopoly impossible. Especially if there's government regulation involved.

Do I need to write a list of all the things that "have always been here" until they were eliminated in the 20th century? Smallpox, high infant mortality in the West, European wars... Besides, poverty, like all those things, isn't just a yes/no question. It's a question of degree: How many people are poor and how bad is their poverty. Of course it's extremely unlikely that poverty will ever be completely eradicated, but it is possible to greatly reduce it - so that no one is in danger of starving, for example.

War and disease are both factors that, to an extent, society frowns upon. And of course people claim to frown on poverty as well, but in truth they ignore it. And perpetuate it. Smallpox was all but wiped out because people wanted it gone, and understood that it was a killer that could eventually reach them, with no recognition of class or culture. Wars, I think, are less common because the grunts are more aware now, and don't want to die. I mean there's almost an outcry every time someone dies in Iraq. A hundred years ago a single casuality wasn't even a footnote in some officer's letter to his superiors.

But poverty is something that keeps going because people don't think it will hit them. They see no risk to the self, and so ignore it. They might feel a bit guilty, but won't lose too much sleep.

Anyway, I'm not saying that poverty is some ever-present foe, never to be defeated. Just that the majority don't care, and the majority make decisions. It'll be a real uphill struggle to combat it, because it involves an admission on the part of those not in poverty that they are partially responsible. And a serious desire to change, and help others. And a genuine empathy for fellow humans that they have never met. And call me a cynic, but I just don't see that happening. Ever.

I'm not so sure eradication of smallpox was such a great idea anyway. Or low infant mortality. I mean it's all well and good to say that more people are alive thanks to these measures, but these people need food, space, money, resources, etc. Overpopulation is bad enough without removing the big killers. That's why those health advertisments always annoy me. "This disease has killed so many hundred people in the last year. Give us money to get rid of it." These people will only be happy when disease of all kinds is eradicated. What a horrible idea.

The temporary legislation makes matters worse by perpetuating poverty and dehumanizing the poor.

So not much will change then.

That would lead to social collapse. If people know that the government will not protect them from theft and murder, they will (a) start defending themselves by any means necessary, and (b) become thieves and murderers themselves. The government would lose all legitimacy in the eyes of the public. You have to keep in mind that the only reason the government is able to exist in the first place is because most people obey its laws voluntarily. There is a limited amount of disobedience that any government can deal with. Peaceful civil disobedience by a large minority (not even a majority) of the population is enough to bring down most governments. Violent disobedience by a majority would lead to complete social collapse in a matter of days or weeks.

If violence is legalized, it generates a feedback loop: The only way to defend yourself from armed gangs and Thieves' Guilds would be to set up your own armed gang. Thus the number of armed gangs would grow until society as we know it no longer exists.

Martial law and urban warfare. Well, it would make an interesting change.

Seriously though, the system has some advantages. A thieves' guild officially sanctioned by the government would have rules and regulations, and contribute a great deal to the country's coffers. The poor wouldn't be robbed so much because they have nothing worth stealing, and the rich would be able to pay to prevent thievery (well, it is a thieves' guild). It would have a complete monopoly on most kinds of crime, and would therefore be able to crush any freelancers. I imagine a country-wide guild would be far more effective at policing crime than the police could ever be, not only due to the nature of the guild but because they stand to lose money if freelancers are allowed to opperate, and thus it would be in their interests to work with the government.

The public would be robbed perhaps once or twice every five years, and avoid more frequent stuff by production of a recipt. Heh heh. And the most vulnerable people wouldn't be robbed at all because a) they have nothing worth stealing and b) the rules of the guild. Any member who broke those rules would of course be treated very harshly, because if crime becomes disorganised then the public can't put any faith in their recipts, or the word of the guild. They would cease to trust the guild to be regular and honestly dishonest, and the whole thing would break down. So it would also be in the interests of the guild to police its own ranks very thoroughly indeed.

If people objected, well they needn't do so violently. And if they did, there's the knowledge that the thieves' guild has several hundred (thousand?) other members, some of whom might be rather upset if their friend loses an eye. Or alternatively, the guild could just blacklist the person in question. Never rob from them, but turn a blind eye if freelancers were to move in. If a community turned the guild out, they would open themselves right up for a far more murderous breed. And this isn't even touching on the whole subject of an assassin's guild (which would charge massive fees in order to prevent misuse, and would also police murder in the same way that the thieves police crime. Can't have people being killed for free. The masses would find it unaffordable, and the rich would be able to pay for protection).

It's not such an impossibility, I think. Extremely unlikely perhaps, but society should be able to funcation alright. People will swallow anything, eventually. ID cards, DNA databases, illegal wars...

Anyway, this is offtopic. Back to organs. It'll happen anyway. Why not make sure it's done right?

[Acriku]

Are we ignoring the benefits of a larger organ market or is this not as good of a benefit as I presume it is?

[Andrew]

I'm all for donating organs (for when your dead and you don't need them..). But Selling organs is kinda wierd. Guess I'll sell my lung for $10,000. With being able to sell organs, it would open up a market where people could sign agreements with companies that when they die they can have their organs for a price, and the proceeds will go to the estate. Then organ donations would fall, as they would all be getting $ for them. And then the public health would have to eithor not ahve any organs, or they would ahve to purchase them from the market, which would add a burden to healthcare which would have to be paid for by taxpayers. If you lived in a non universal healthcare area, then you yourself would have to buy organs.

People that don't donate their organs are kinda selfish, as they can help another person live, even though you are dead.

Sure I'll buy some insurance premiums stating that if my organs are in good working order when I die, then my estate will get even more $$$ as the insurance company (or organ company) will buy my organs.

Unless we are talking about selling organs while alive. I don't quite see the point of me selling an organ while still functionally alive and well.

[Dude_Doc]

I agree with Andrew - dead people simply don't need their organs. But I'd rather put my faith in machines. A synthetical heart or lung, some decades from now, could resist cancer or heart problems. About poverty, well, it has to disappear somewhere in the future...

[Dante]

Does it? I see it disappearing when there are no more people left to be in it.

Nobody's really objecting to donating organs once dead. I don't plan to donate mine of course. I'm vindictive like that. And also I might yet find a use for them post mortem. It's selling organs while alive that we're talking about. Short-term gain for one person vs long term bad things for everyone. And some people might decide that they need the money more than a kidney. They've got two after all. Most people have, anyway.

[Andrew]

It would be taking advantage of low income people stupid enough to sell organs (to possibly support drugs/alcohol/gambling etc).

[Dante]

Hence a requirement for legalisation and regulation. Also I wouldn't generalise them as stupid... just desperate.

[Acriku]

Am I the only one considering the long-term benefits of selling your organs? People are in need of new organs daily, in fact there's such a long waiting list for organs that the odds are against you getting one. If a guy wants to sell his kidney, let him. He'll get a lump sum to (optimistically) begin investments and entering into the job field, and a person will live because of him. My brother has one working kidney, and if that fails then I am the first in line to give him another (same blood type). But if I wasn't here, legalizing the sale of organs would benefit him.

With that in mind, the social damages can be alleviated if only somewhat by some sort of regulation. But besides that, if people are allowed to sell their time and effort working at some factory (even risking injury) in order to fuel their bad/illegal habits, why can't they sell their organs to do the same? The organ is needed by someone somewhere, so I am fully with legalizing it.

[Edric O]

Ummm, first of all, it really wasn't my intention to start a topic on the selling/donation of organs. I was only using that as an example to make a point about freedom of choice.

But I wish to respond to Acriku anyway: Whether organ selling has long-term benefits or not depends on who is allowed to buy those organs and what they are allowed to do with them, which is an entirely different question.

If anyone is allowed to buy organs and do whatever they want with them, you will quickly find corporations (perhaps drug companies) opening up entire departments to buy and re-sell organs. The organ trade would become big business, and very likely be concentrated in the hands of an oligopoly (there are substantial economies of scale in harvesting, storing and transplanting organs - oligopoly is inevitable). This oligopoly would have complete control over all organ transplants, since free donations would dwindle away to nothing if people could get money for their organs.

To make matters worse, the supply of organs would be extremely inelastic, and the demand even more so. In other words, the number of people willing to supply organs will not go up very much as the price of organs increases (beyond an initial burst right after legalization, of course). Only people in desperate need of cash will ever sell their organs, so the supply could not respond to demand. The demand itself can never respond to supply either; people won't start asking for more organs if the price goes down ("hey, kidneys are cheap! let's buy some"), and they won't be asking for less organs if the price goes up. ("damn, lungs are so expensive these days - I guess I'll go without")

So let's recap: we have imperfect competition (oligopoly), inelastic supply and essentially fixed demand (not in the sense that it's always the same, but in the sense that it doesn't depend on the market). This is a nightmare of a market, which is unlikely to ever work properly or reach any semblance of efficiency. Also, please note that both oligopoly and inelastic supply tend to result in a high equilibrium price. In other words, organs will be selling for a lot of money. Your brother probably couldn't afford buying a kidney on this market anyway.

[Edric O]

Dehumanisation is easy enough anyway. And furthermore, there are only a limited number of organs that people can sell. One kidney, a bit of liver, perhaps some gut and if desperate a lung. After a while you run out of bits to sell, and turn to other methods of getting cash. The organ industry would certainly grow, but the very nature of the stuff makes a monopoly impossible. Especially if there's government regulation involved.

I'm not sure exactly what kind of regulation you have in mind, but a market in organs would very quickly split in two markets, with large companies as middlemen. This is because it is highly unlikely for a person willing to sell a kidney to just randomly walk into someone who happens to need a kidney. Rather, the seller would sell his kidney to a company who would put it in storage and later re-sell it to someone else. So you end up with two markets: one market for people selling organs to corporations, and another market for people buying organs from corporations. Those corporations would be relatively few in number and represent an oligopsony in the first market and an oligopoly in the second. Why? For the same reason most health markets end up as oligopolies: it takes a lot of money to set up the proper medical facilities to harvest, store and transplant organs. You also need skilled doctors. It's not the kind of business for the average Joe.

Government regulation might prevent the few corporations from forming a cartel (or worse, merging into a monopoly), but they still keep a lot of power.

Oh, and by the way, precisely because there are a limited number of organs that people can sell (and a limited number of people willing to sell them), supply in the organ market would be highly inelastic - that is, not too responsive to demand. See my post above.

War and disease are both factors that, to an extent, society frowns upon. And of course people claim to frown on poverty as well, but in truth they ignore it. And perpetuate it. Smallpox was all but wiped out because people wanted it gone, and understood that it was a killer that could eventually reach them, with no recognition of class or culture. Wars, I think, are less common because the grunts are more aware now, and don't want to die. I mean there's almost an outcry every time someone dies in Iraq. A hundred years ago a single casuality wasn't even a footnote in some officer's letter to his superiors.

But poverty is something that keeps going because people don't think it will hit them. They see no risk to the self, and so ignore it. They might feel a bit guilty, but won't lose too much sleep.

Poverty is no different from war or disease: It could happen to anyone. And if the "grunts" are less willing to die in wars, the "rabble" could just as easily become less willing to languish and starve in poverty. That has in fact already happened to some extent; why do you think the socialist and communist movements got started?

Anyway, I'm not saying that poverty is some ever-present foe, never to be defeated. Just that the majority don't care, and the majority make decisions.

Actually, the majority do care, but they don't make the decisions. Our supposedly democratic governments don't really follow the wishes of the majority; they merely refrain from going too far against them.

[Dante]

An unworkable system is by definition impossible to utilise. If private companies removed themselves too much from the actual buying and selling of organs then they would probably collapse. It's in a company's interest to provide a stable enviroment. The system would be no more inelastic than it currently is, with voluntary organ donations from dead people being the only source.

If it were controlled by the government though, which is what I actually meant before, then the profits could be channeled back into the population. And if anyone else set up the same business, they wouldn't be quite so effective at getting 'customers' because the nationalised service would be cheaper. I'm not sure about the crazy systems that the rest of the world uses, but today in Britain we have a choice between private and government healthcare. Private is expensive but high quality and much faster. Public is free, good quality mostly, but quite slow. I don't see why this couldn't be applied to organs. Of course if the government were to buy organs and then give them away then it would need substantial subsidies, but that's no different from the national health service anyway, which is horribly underfunded as it is.

The socialist and communist movements started because someone who wasn't in poverty started giving those who were ideas. Which seems both a little ironic and a bit dim.

Poverty could hit anyone, but if you're prudent then it is far less likely to when compared with disease or war. That's what people believe. War and disease kill without respect for any differences. Poverty only claims those foolish enough to wander into it. Note that this isn't my belief, but what I perceive common opinion to be.

By retaining their governments, the majority implicitly express either support of or neutrality toward the government's actions.

[Anathema]

I came upon a libertarian blog whose author had recently made a post fiercely advocating the legalization (and deregulation) of selling one's organs.

Very bad idea, for exactly the reasons you have outlined.

While some liberal ideas are noble, it's also downright naive to assume that deregulation of everything is in the best interest of everybody, or even the majority of people.

Health care is one area that has to be state regulated to ensure equitable treatment for all.

[Dude_Doc]

Does it? I see it disappearing when there are no more people left to be in it.

Exactly. That is why I believe we must work towards such a future.

[Dante]

A future when there are no more people left to be poor? I.e. one where everyone is dead? Well, if you want. I'll only complain when you get to someone I know.

[Dude_Doc]

I.e. one where everyone is dead?

No. One where mankind works for the best of mankind, not for profit. But looking at your previous arguments I guess you oppose such a future.

[Dante]

Not as such. After all, being part of mankind I am due to benefit if mankind does. It's when mankind's interests conflict with my own that I start opposing. Also I don't believe that it will ever come to pass anyway.

The point of the 'no more people left' bit was to imply that everyone will be dead before poverty is eradicated. Your 'exactly' seems to have missed that.

[Dude_Doc]

Not as such. After all, being part of mankind I am due to benefit if mankind does. It's when mankind's interests conflict with my own that I start opposing.

But something in the sense of what I said...

The point of the 'no more people left' bit was to imply that everyone will be dead before poverty is eradicated. Your 'exactly' seems to have missed that.

Hmm, yes I must have misinterpreted it. From a perspective, it could be that there are no people in such a condition that it could be called poor, thus leading to poverty.