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Btw. I find the description "cynical" puzzling. It is a historical fact, that ordinary Germans in the vast majority supported Hitler right until the very, very end. With good knowledge of the existential persecution of Jews and horrible war crimes. They knew - as historians have shown. That's the vast majority of human beings. And I don't think somehow Germans are exceptional. I believe we're all Germans. Which means that I disagree with "most people are basically good" not for reasons of cynicism, but for reasons of compelling historical evidence. You only have to look. If I was more ornery, I could claim that rather than me being cynical, evidence - EVIDENCE - shows that it is Dean who is willfully blind :)

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Tom,

 

So sorry, but no way, no how am I going to get my kidney ripped out, so that Joe the Plumber can get an extra 10 years to waste oxygen or worse.

 

Wow. Harsh. By your argument, I presume you would be opposed to the government spending your tax dollars on medical care for "bad people" in prison. Why not withhold food from convicted criminals while we're at it?

 

Should doctors be responsible for researching the background of everyone they treat, and leave to die those they judge to have a bad character or whose bad choices got them into the medical pickle they find themselves in? What about not serving someone at your restaurant because you heard they left their wife and two kids to run off with their secretary? 

 

I'm all for researching one's charitable efforts, and trying to optimize the good that you do. But again I think more people have a good heart than a bad heart (in the figurative sense), and moreover, the sort of attitude you express can lead to callous disregard of human suffering, if not eventually to vigilante justice.

 

Finally if we all hunker down and look out only for ourselves and those close to us, the "bad people" advocating such selfish isolationism have won. Nazi Germany was a long time ago. Read Stephen Pinker's Better Angels of Our Nature for at least some dollop of hope that our sense of responsibility and compassion for others has been improving over the years. I'm not an optimist that it is improving fast enough to keep us from killing ourselves and the planet, but without hope we are simply throwing in the towel and giving up.  

 

--Dean

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I coudn't disagree more. "Nazi Germany was a long time ago" - this I could characterize very harshly, but won't. There are people alive TODAY as we speak, who have experienced the full horror of Nazi deathcamps, who are speaking out against our government actions TODAY, bless their souls - please take 2 minutes out of your day to see this witness to history making an analogy right now:

 

https://youtu.be/uF8u3aPvlKk

 

He certainly doesn't think that "Nazi German was a long time ago" - he thinks that what he PERSONALLY experienced is relevant today, to our actions today, to the actions of our governement, and how history will judge those who are the agents of such actions TODAY. We are not talking ancient history.

 

And Dean, I'm pretty disappointed and surprised by how unreflective and poorly thought out your statement was. You're a thoughtful individual. "Nazi German was a long time ago" is a statement so wrong, it's breathtaking. Not only because it is immediately contradicted by plain facts of people alive today who experienced it. It's not a long ago history, and it's relevant today. But by the fact that the implied idea is that somehow because "it was a long time ago", human nature has changed and such events can teach us nothing - as if there has been no genocide since then, as if Rwanda or Cambodia, or dozens of other examples, including right as we speak in Darfur, as if all those never happened. Human Nature has not changed in the 70 years since WWII, or since the 5000 years ago of Babylon. We're basically the same species with the same pychosocial dynamics. That is how a majority of people in countries TODAY can commit or encourage or be complicit in GENOCIDE (see f.ex.: Burma and the Muslim tribal minorities).

 

"Nazi German was a long time ago" - wow. Wow. Wow. Breathtaking.

 

So yes, the majority of people is capable of being supporters of Nazis. Majority. Today. Human Nature has not changed in 70, 700, or 7000 years. Do you doubt, for one second, that we, Americans, cannot commit genocide? Or was the Civil War and Slavery also "a long time ago", the consequences of which we still experience today, downstream from Jim Crow and the rest? Have you just missed the fact that a genuine fascist was elected in our democracy in 2016, or was that also a long time ago? And that he immediatly started ripping families apart, as the death camp survivor pointed out in that heart-wrenching video, or perhaps you need to see the video of a young girl sobbing while she films her father being arrested by jack-booted ICE agents when he was dropping her off at school:

 

http://www.cnn.com/2017/03/03/us/california-father-ice-arrest-trnd/

 

I have not read Stephen Pinker, but if he maitains that somehow human nature has changed in 70 years, or that similar atrocities are not happening RIGHT THIS SECOND, or that we are not - the MAJORITY OF US - are not capable of exactly the same things as the "ordinary Germans" were70 years ago, then he's an idiot whom I have no interest in reading.

 

Your other points about prisons/restaurants/doctors and the like are strawmanning - we are talking about *voluntarily* donating, not running a business that has an obligation to serve everyone, or running a prison that has constitutional limits within which it has to operate. By the same token, don't forget, obeying unjust laws is not commendable, that's why "I was only following orders" is not a defence, even if you were following the (bad, criminal, genocidal) law, and contrarily, defying the law is the ethical thing to do (see: civil rights and resistance).

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Tom,

 

You misinterpreted me completely. I'm not saying we should forget the lessons of Nazi Germany, nor that similar atrocities aren't continuing to occur today. They are, but thankfully to a (somewhat) lesser scale as Pinker points out. We're certainly not significantly different biologically than we were 70 (or 200) years ago. But our cultural institutions have evolved to some degree, making violence and hatred less acceptable - not everywhere, but at least in more economically developed nations where material abundance has taken the edge off the struggle to survive.

 

What I'm arguing is that by focusing on the bad in people, or their bad potential, we create a self-fulfilling prophecy. By giving overwhelming regard to ourselves, our friends and our family, while withholding regard for those more distant from us, out of concern they may be bad people or have the potential to become bad people given the right (or wrong) circumstances, we play into the fear narrative that is leading us down the path of self-destruction we seem to be on right now as a nation and a world.

 

Call me naive if you will, but it seems to me that compassion and trust in the kindness of strangers may be the only way out of the death spiral human society seems to find itself in at the moment.

 

--Dean

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I'll grant you that you make some good points, but once again I think we'll have to agree to disagree. Beyond the inequity issues, I've read a number of horror stories from countries in which selling kidneys is legal (e.g. Iran and India) and where coercion and forced sale by the desperately poor is commonplace. Becoming a donor for either a loved one or a stranger is a hard enough ethical decision to make without financial incentives. Adding money into the mix would make it hopelessly complicated and fraught with ethical dilemmas.

 

You may disagree, but from my perspective there are some aspects of life that should remain outside the scope of financial market forces. Organ donation is one of them.

 

--Dean

 

Iran is the only country in the world where selling kidneys is legal, though not to foreigners.  For what its worth, if a well off person wanted to (illegally) buy a kidney, the going price is $53,000 to $122,000 (all inclusive, haha).  But the donors are only getting $6,000 and the surgeon is only getting around $2,160, that's a LOT of inefficiency that doesn't need to exist all because its illegal!

 

India and Iran are both systemically corrupt.  I really don't think it would be a big deal to require and enforce a program in the US that involved competent health (mental/physical) screening, case review, and informed consent.

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Thanks Dean for clarifying - I now am clear, that, at least in this instance, Pinker is a moron: "They are, but thankfully to a (somewhat) lesser scale as Pinker points out." They only reason why the scale is different is not because "our cultural institutions have evolved to some degree, making violence and hatred less acceptable", but because the scale of conflict is smaller - Pol Pot (decades after WWII) murdered MORE of his own population by percentage than even Hitler or Stalin, and the only reason why the number of victims wasn't bigger in absolute numbers is because he had control over a smaller number of people. The same for Rwanda, or Darfur or any number of examples. Hatreds have DEFINITELY not become less acceptable. For that matter even in absolute numbers Mao was responsible for more deaths than Hitler. So that's just a patently idiotic argument from Pinker (if indeed that's his argument) and completely ahistorical - the number of victims and scale of destruction is limited only by immediate geopolitical circumstances and not by "evolved cultural institutions". Nor can one find refuge in thinking it only applies to those savages in third world countries "at least in more economically developed nations". History has a lot to teach us, no matter how long ago - including yet again, Nazi Germany. Please remember, that during the Weimar years, Germany had the most liberal culture of any nation on earth - where for example gay people were more open in their identification and life than anywhere else on the planet. And yet, a few short years later, they were in concentration camps wearing pink triangles. These "cultural institutions" are a super thin veneer, that will be ripped off with breath-taking speed once the conditions are right. Anybody who doesn't undertand that, knows nothing of history. For that matter, we saw it only a few decades ago - when the former Yugoslavia unravelled, and concentration camps and ethnic cleansing took root in the middle of enlightened Europe, in a region that was relatively successful economically and people were not struggling to survive (indeed Yugoslavia was quite economically successful).

 

In short, I 100% disagree with your view. I see these periods of relative stability around us, as always sitting on a volcano waiting to explode. History tells us, that human nature is immutable, and that those who proclaim that "it couldn't happen here" are invariably wrong. When the time is right, and the circumstances are right, the thin veil of civilization will be ripped off and human nature will be exposed, yet again. Freedom, Justice, and Equality are something that has to be constantly and vigilantly fought for, because the moment you take your eye off the ball, disaster happens (see: Trump). Nothing is guarateed. All must be worked and fought for. Human Nature does not change. Count on it. 

Edited by TomBAvoider

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Tom, what would you make of Peter Signer's famous thought experiment:

 

If I am walking past a shallow pond and see a child drowning in it, I ought to wade in and pull the child out. This will mean getting my clothes muddy, but this is insignificant, while the death of the child would presumably be a very bad thing.

 

That child might grow up to be a lousy person, even in the totally banal sort of way that most of us can be bad people complicit with all kinds of atrocities, just as you and I are complicit in torture, sweat shop labor, unprecedented and catastrophic environmental destruction, etc. But that kid should prove he deserves to be saved before we save them? The default position is that human nature is rotten so it's probably for the best not to save any random person? Does the kid just need to prove they will be better than average or do they need to be among the very best in order to deserve saving?

 

How is someone on dialysis any different?

 

If you, through some set of circumstances, end up on dialysis yourself, would you consider an additional seven years of healthy life made available from a kidney donation from a stranger to be worth while?

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If you, through some set of circumstances, end up on dialysis yourself, would you consider an additional seven years of healthy life made available from a kidney donation from a stranger to be worth while?


 


Oh that's easy. My default position has always been: I count on nothing from anyone. And I'll do anything not to be a burden to anyone. I try to minimize my footprint and take as few resources as I can possibly manage. If I were, for example, to learn, that I have a terminal disease, I'd make sure to shove off under my own power well before I'm rendered a vegetable - I would not try to prolong my life at any cost. Were I to find myself in the situation you describe, my attitude would be: that's how the cookie crumbles, unfortunate, but c'est la vie, I have no regrets; I certainly count on no one, and I'm ready to face the (short) future. Easy-peasy. FWIW, I've had a tiny preview when I had a serious motorcycle accident twenty years ago. As it was happening, time seemed to stand still - I knew I could die, and I was serene. No panic. No fear. And as I lay in the hospital, not once did I worry about my ultimate fate. So I feel  I have a pretty good handle on death and the nothingness to come (as it inevitably must). 


 


 


That child might grow up to be a lousy person - that's only potential though. I can't test that potential to see if a Hitler or a rando terrible jerk grows up - so I save the kid. But that's not the case with actual adults - there the test has already been run, and they're either terrible or not. And if they can be tested, they should be. After all, we means test people all the time - we qualify them for all sorts of things, including social assistance of all kinds. We don't just say "serve everyone, no questions asked". So too here - adults on that list, I'm not just throwing a kidney at them going "anyone and everyone, no questions asked". I want them qualified and means-tested. A kid - that's different, we can't qualify as they're mere potential and we have no choice but to take a chance. With adults, we have a choice.


 


do they need to be among the very best in order to deserve saving - about people, in general, it all depends, doesn't it? For some things, almost all deserve saving - if it's a matter of small/negligeable cost. But if the cost is higher, you bet your sweet life that we already make that calculation - after all, government and insurance companies already ask the question "how many resources should we expend to save this person"? We live in a world of limits on resources, unfortunately. And so we make that calculus - we'll prioritize the person who is younger to receive a transplant vs someone who is unlikely to have many more healthy years. And so on down the line. We already make decisions as to who deserves saving more. So too it is for me. If it were a matter of something that I could easily afford, then the only criterion for me would not be "are they among the very best", but rather "as long as they're just not terrible - that's good enough". But a kidney - of which I only have one to give away, and at great personal cost (in health) to boot, you bet your sweet life that the qualifying would escalate dramatically... just as it already does for government health decisions, though using a different scale, of course as they have different concerns.


 


It is easy to see one's own perspective as a moral one and a different perspective as less moral. But the truth is, it's just a different perspective. For example, I understand perfectly well, that you (perhaps) see it as a moral position to say "I make no distiction, I give freely as the need arises". So I acknowledge that your perspective (if indeed that is your perspective) is morally consistent to you. But perhaps you can see that a different perspective might be moral to someone else. Because my position is that it's making a conscious choice is in fact the moral position - I see it as a basic ethical obligation, to interrogate the outcome of my actions, including my giving. It would be a cop out for me to say "oh, don't trouble your little head over who is deserving or not, it is for the gods to know, not for a mere mortal man, who deserves your gift and who does not". It is a way of saying "I'm off the hook, I don't have an obligation to be accountable for the consequences of my actions, because of the principle 'everyone is deserving'". The reality is that I could give a kidney to a terrible person (or Terrible or TERRIBLE person, even if less likely), and thus increase the net misery of humanity. My "generosity" was in fact a stupid indulgence that boomeranged terribly against humanity and was a net loss to civilization. A bad action. Meanwhile, I shot my wad on a terrible person at great cost to myself and at perhaps a great cost to somone actually deserving of my kidney (like my wife)... only now I've given it to Chester-molester, or just rando-terrible, what GENIOUS! All because I forewent the trouble to vet my own actions and relying on a smarmy "principle" that's really just a giant cop-out. No. The moral thing to do is to go ahead and do the hard work of yes, choosing, the hard decisions and the difficult choices. It's like those folks who say "government should fund end of life support to people at any cost ALL ARE DESERVING AND NO LIMIT TO COST" - because that's an easy position to take and make oneself feel good about being a "good guy", while not having to actually make the hard choices and square the budget and deal with reality. So there - I went on for such a length to illustrate: we all have different perspectives and it's a mistake to immediately think that only one (my own, of course!) can be valid. There are valid and moral reasons for a whole host of perspectives, and while we can agree to disagree, we should not make the mistake of underestimating the coherence or deeply felt moral impulses of another person.


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Fascinating Tom.

 

You appear to extol a ethic that is a hybrid of libertarian (everyone should look out for themselves and their intimates, and engage in social exchange only to the extent that it benefits themselves and their intimates), and 'informed consequentialism' (it is good to help others, even people distant from you, so long as you can vet them to make sure they are 'good' people, and therefore deserving of your assistance, while giving the benefit of the doubt to children and animals). Please correct me if I'm mistaken in characterizing your outlook.

 

The first half of your ethic looks a lot like the 'rational egoism' that moral philosophers have thought about for millennia. Henry Sidgwick, one of the unsung but influential founders of utilitarianism, thought rational egoism was impregnable - i.e. he thought (and bemoaned) that it was impossible to disprove the belief of a rational egoist that the world would be a better place if everyone simply looked out for their own interests, and didn't solicit or partake in the kindness of strangers.

 

But I think the perspective of the rational egoist, particularly if melded to the informed consequentialism that is the second part of your ethic, can't be defended by anyone (including yourself) who benefits from living in a complex modern society. Our world is replete with examples where each of us (including you Tom) benefit strangers in substantial ways, and benefit from strangers in substantial ways, without knowing them, to say nothing of vetting their moral character.

 

Here are just a few examples (I'll focus my main example after this list on kidney donation, since that's the topic of this thread):

  • As a US citizen, you presumably pay federal, state and local taxes. Your hard earned money goes to pay for services to people whom you'd consider 'bad' or at least not deserving of your assistance. In particular, a large fraction of your state/local taxes presumably go to pay for the education of children who aren't your own. Some of these kids (high-schoolers) will already be incorrigible 'bad' people, date rapists, drug dealers, or kids who torture animals and who'll in all likelihood grow up to be psychopaths. 
  • Presumably after your motorcycle accident, people came to you assistance. Perhaps it was a passerby who called 911. Or the paramedics who stabilized you and brought you to the hospital. Or the doctors who treated you. By your ethic, anyone of them could and should have left you to die, since they couldn't vet you to determine if you deserved their assistance. For all they knew you might have been a pedaeophile. 
  • Would you have refused a blood transfusion after your motorcycle accident if you needed one? After all it was the kindness of strangers who selflessly donated their blood to benefit someone they could not vet (you).
  • If your hospital costs during your recovery were substantial, your insurance company likely spent more on medical care for you than you'd paid in premiums. That was certainly the case for my son's cancer treatment. You (and my son) were relying on the kindness and cooperation of strangers (other people who paid into your insurance plan), who didn't vet you (or my son) to see if you were worth saving.
  • Or maybe you paid for your medical care out-of-pocket. But even that doesn't cover the full cost of your treatment. For example, the education of the doctor who treated you was subsidized by both the government (through low cost student loans) and/or through the alumni of the med school your doctor attended, who donated to their alma mater to help subsidize student tuition. Once again you are relying on the kindness of strangers.
  • Heck, even you're helping of animals could backfire. What happens if one of those animals you rescues goes rogue tomorrow and kills a child. You can't know the ultimate downstream consequences of your action, however hard you try to vet those you help.

 

But let me focus instead on the kidney transplant case. Remarkably, you said (true to your ethic) that you'd refuse the kindness of a stranger willing to give you their kidney, no questions asked. Right off the bat this seems irrational to me, even by your own ethic. Presumably you know yourself to be a pretty good person, who does more good in the world than bad, and so deserves to go on living. Are you saying you'd refuse to be saved by the kindness of a stranger who is willing to give you the benefit of the doubt, simply because they are uninformed about your true character? Even if you (crazily, IMO) say yes you'd refuse, it seems then you should have waved off the paramedic who came to help you after your motorcycle accident. After all, c'est la vie. That paramedic didn't know whether you were a person who deserved to be saved either. Sure it was their job, but they were under no obligation to help you. You said yourself compliance with an unjust law is no excuse. It seems clear to met that the same should go for complying with what you consider to be an unjust ethic (helping strangers who might be bad people). That paramedic was well within his rights, and perhaps it was even his duty by your ethic, to withhold treatment until you demonstrated your worthiness to be helped. If you couldn't prove it (e.g. if you were unconscious) or he didn't believe you, he should have left you to die. 

 

But let me now take a different tact. Suppose you needed a kidney, and luckily you had someone (your wife perhaps) who had vetted you and found you deserving of their sacrifice. But sadly for you, she turns out to be incompatible, so she can't give her kidney directly to you. In order for you to get a kidney, you'd have to join a paired exchange like the NKR. Your wife would donate to someone else, and in return someone else would donate to you. Seems like the sort of quid pro quo you might buy into. 

 

But if you think a bit further, with your wife's donation of her kidney to a stranger, your wife would be helping someone who she cannot vet, since people's identity is never revealed ahead of time in such kidney swaps and chains. Would you say "No can do wifey, I can't risk you helping someone who might be a bad person, even to save me."

 

If you would refuse to allow your wife to participate with you in such a swap, you are remaining true to your moral code, but are being pretty irrational, IMO. If you say it's ok to potentially help a 'bad' stranger  in this circumstance because it benefits you, you're not only be cynical, you're being selfish and hypocritical - willing to compromise your principle of only helping people who you know deserve it, so long as it benefits you.

 

Or what about if the roles are reversed? Your wife needs a kidney but you, as a willing donor, are incompatible with her. Would you be unwilling to donate to a stranger 'downstream' in the chain in order that your wife might get the kidney she needs to survive? After all, you couldn't vet the person who gets your kidney to make sure they are a good person who deserves it. Would you tell your wife she can't ethically accept the kidney of a stranger (perhaps a 'naive' and undiscerning good samaritan like Thomas) simply because he wasn't able to vet her to verify she's a good person? 

 

Or how about this. What if you were compatible with your wife, but she could get a more compatible kidney by joining a paired exchange like the NKR? The better match kidney might given her 5 extra years of healthy life. But to get it, you'd need to give your kidney not directly to your wife, but to a stranger who you can't vet to be a good person. Would you instead refuse and give your wife your kidney directly, shortening her life by 5 years, on the off chance your kidney might go to a bad person?

 

In our modern world we are inextricably intertwined with a multitude of strangers. Kidney exchanges like the NKR are just an extreme example. We help others through our choices, and they help us through theirs, all without being able to know whether they are good people or bad. The produce manager who sold you your kale might be a wife beater or child molester, but you're supporting him with your purchase. And he's helping you by selling you his leafy greens without knowing whether he's helping a good person or a serial killer.

 

We can't help but rely on the kindness of strangers and render kindness to strangers in turn. The only way to avoid these sorts of arm's-length social exchanges with (potentially bad) strangers would be to go live an entirely self-sufficient lifestyle with your wife in an isolated cabin in the woods, chopping your own wood and growing your own food.

 

You obviously don't do that Tom, so it appears to me your ethic is untenable and indefensible in a modern society. It seems to me you are being hypocritical by espousing it while benefiting from all the good things strangers have done for you.

 

--Dean

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I also find your response fascinating. There is a lot to respond to but I just want to focus on one. You write: 

 

But if the cost is higher, you bet your sweet life that we already make that calculation - after all, government and insurance companies already ask the question "how many resources should we expend to save this person"? We live in a world of limits on resources, unfortunately. And so we make that calculus - we'll prioritize the person who is younger to receive a transplant vs someone who is unlikely to have many more healthy years.

 

We do not have a scarcity of kidneys! The scarcity is totally artificial. The planet as seven billion plus people on it, most of us have two fully functional kidneys. We live in a world of radical abundance and have to actually work pretty hard to impose an artificial scarcity.

 

The cost of keeping someone on dialysis is pretty expensive. The cost of a kidney transplant is relatively inexpensive. If we want to put the emphasis on the wisest use of limited money, the numbers are overwhelmingly lopsided in favor of a radical increase in organ donations. You could even frame it in a way that seems consistent with your guiding moral framework here, to not donate our good kidneys is being a burden on others, if for no other reason than that it will place the cost of 100,000 people on dialysis onto all of us.

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C'mon, Dean, this is so inept, it's like you're not even trying. I cannot believe that I'm seeing here rhetorical moves that we all outgrow soon after leaving the schoolyard. In this case it's the ever popular "missing stair" of this form:

 

1)I have pants

2)Everybody needs pants

3)???
4)Profit! I'll make a fortune off pants

 

Perhaps, though that missing step (3) might be a wee bit of a complication you shouldn't just gloss over. 

 

Our world is replete with examples where each of us (including you Tom) benefit strangers in substantial ways, and benefit from strangers in substantial ways, without knowing them, to say nothing of vetting their moral character.

 

Thanks, Captain Obvious. Now, how do we derive any actionable conclusions from this gauzy generality? Here, let's try this one:

 

1) It's good to give up lunch money for a worthy cause  

2) Hand over your lunch money to me

3)???

4) Goodness achieved!

 

Is your breezy observation supposed to tell us that since we frequently have no chance or ability to vet people for whatever cause or reason, therefore any social scheme or entherprise should desist from vetting people along any line including moral character? Because if you answer "yes", then that's inane, and if you answer "no", then WTF is the point of your statement, other than empty bloviation?

 

A public service reminder: stating generalities without specific applications renders the generality either false or banal. 

 

a large fraction of your state/local taxes presumably go to pay for the education of children who aren't your own

 

I have no kids, but am happy to pay taxes for other kids education etc., because it's in the public interest.

 

Some of these kids (high-schoolers) will already be incorrigible 'bad' people

 

That can't be helped, as we don't know ahead of time who will turn out that way. That doesn't mean it's good, that some kids turn out that way. If we already DO know that some kids are psychopaths, we'll try to get them psychological help, and if that doesn't work, we'll do what we already do: Juvenile Hall (with hopefully better help than present day juvies). And when they grow up to be psychopaths despite our best efforts, we'll throw the book at them - certainly we won't be appealing to people to voluntarily turn their kidneys over to them. What seems unclear to you? Or do you equate compulsory taxation for the common good to voluntary giving based on one's own ethical priorities?

 

 

  • Presumably after your motorcycle accident, people came to you assistance. Perhaps it was a passerby who called 911. Or the paramedics who stabilized you and brought you to the hospital. Or the doctors who treated you. By your ethic, anyone of them could and should have left you to die, since they couldn't vet you to determine if you deserved their assistance. For all they knew you might have been a pedaeophile. 

 

 Sigh. Like I said, it's as if you're really not even trying.

 

I had very good insurance, for which I paid high premiums for literally decades, before my accident. I certainly put in a lot more into the system at that point than I got out (as most people do), as I was generally very healthy. My insurance coverage included emergency services, ambulance, and so on. Even IF I were a pedophile, it would've been a breach of contract for me not to receive services I specifically paid for. I don't recall any contract that entitles anyone to my kidney and withholding it is not a breach of contract. Cue here blathering generalities like the one that openend this prepostrous line of argument "social contract" - but it being a generality, is empty of meaning without specifics. And when the specifics are examined, we see the faultlines. One is a contract. That is compelled by the terms of the contract. The other is voluntary, and not compulsory and therefore cannot be compelled - rather it is like charity that might be directed to a cause you deem worthy. People vet their charitable causes. They are under no contractual obligation to support any old cause. Discretion and vetting are part and parcel of any voluntary giving. Same here. Unless the kidney is contractually owed (as in Gordo's scheme), it's my prerogative to not give it to people I deem terrible. Amazing, how fuzzy thinking results from gauzy principles with no specifics. It's pretty effing clear, seems to me.

 

 

  • Would you have refused a blood transfusion after your motorcycle accident if you needed one? After all it was the kindness of strangers who selflessly donated their blood to benefit someone they could not vet (you).

See above. My insurance covered this. And incidentally, not that it mattered to the hospital, but I donated blood in the past.

 

  • If your hospital costs during your recovery were substantial, your insurance company likely spent more on medical care for you than you'd paid in premiums. That was certainly the case for my son's cancer treatment. You (and my son) were relying on the kindness and cooperation of strangers (other people who paid into your insurance plan), who didn't vet you (or my son) to see if you were worth saving.

Um, do you understand how insurance works? Doesn't seem so. Insurance companies SELL insurance with the expectation that on average they'll come out ahead. And they do. That doesn't mean that they don't take a loss on one case - they make up on it with other cases. That's part of the business proposition.  Read that underlined statement and absorb it. They are *selling* you a contract that includes their risk. It is a voluntary contract. Nobody put a gun to their heads. They're a for profit business. They are not doing it out of the kindness of their hearts. Dean, for god's sake, grab a textbook and learn how risk profiles and the insurance industry works, or you're liable to keep making these economically illiterate assertions. People buy insurance not out of the kindness of their hearts so that other people are covered. Nor was it wasn't the kindness of strangers at the insurance company that my care was paid for. It was part of a contract. It's a business. It has nothing to do with good will and kindness. Furthermore, I suspect you don't realize that most insurance companies don't make their money from premiums, but from their profit-making investment of the premiums. That's how they're able to pay out more than they take in from premiums and still turn a profit. So no, nobody is paying premiums thinking "yep, this goes to the needy!". And yes, I paid my premiums, and if an employer paid for part of my premiums so that I had gold plated insurance, then it wasn't because the employer was full of kind strangers, but because they made a business decision that one way to retain me as an employee was to offer benefits. That's part of the compensation for the work value I give them. Just like a salary. They gave me a package of compensation (salary, health insurance, stock, bonuses etc.) - and I agreed to it. It was a business contract. We both benefitted. Dean - I gotta ask: do you understand how salaries work, or do you think salaries come from the kindness of strangers at corporations? Your son's premiums were covered by you. As well they should have been - part of the OBLIGATION of a parent is to take care of your kids (see the penal code on what happens if you neglect your children). It is both a legal obligation, and a moral obligation. Your kid didn't ask to be born, so it isn't a kindness you are extending to him that you covered his premiums. It was your legal and ethical obligation. Incidentally, I favor single payer for medical care, so that the whole insurance industry would disappear as it's quite ineffecient - I believe that medical care should come from taxes, as that's the best for the societal good long term (always my concern). That way kids are covered, as well as adults as a matter of the greater societal good. And yes, I pay taxes.

 

  • Or maybe you paid for your medical care out-of-pocket. But even that doesn't cover the full cost of your treatment. For example, the education of the doctor who treated you was subsidized by both the government (through low cost student loans) and/or through the alumni of the med school your doctor attended, who donated to their alma mater to help subsidize student tuition. Once again you are relying on the kindness of strangers.

Oh dear god, please give me patience.

 

Dean, I beg you - grab an economics textbook, so you don't spout utter idiocy with every keystroke. I really should not have to go through econ 101 with you. Part of being a good partner in an argument is an obligation to be informed at least of the basics. That statement above is 100% nonsense. When a business prices a product, they include all costs PLUS a profit margin. Othewise they couldn't stay in business. In that cost, is included the cost of expertise. Hospitals are a business (unless it's a non-profit). It's like that old joke about someone who complained that a car mechanic just turned one screw and charged $100 - the mechanic responded that you are not paying for the screw turning but for the knowledge of which screw to turn. In other words, when a business - including a hospital - charges for services, they include the cost of the doctor's compensation which includes a fractional value of his education. So when you paid a hospital bill, YOU HAVE PAID IN FULL, which includes not only the fractional cost of the doctor's education, but also the PROFIT. Which brings me to another misconsception you seem to harbor. Hospital bills in the U.S. are way, way, way, outside of any cost structure. We have the most expensive healthcare in the world by a huge margin. We pay A METRIC SHITTON more for what we get in return. I don't have the time to run down all the links, but you are welcome to educate yourself, but briefly, one of the many reasons the prices are so extremely high are the outsize doctor compensation fees. We pay MUCH more than what we get in return. When my hospital got paid for their services - they got paid much, much, much more than what all their costs were including doctor fees. If you pay out of pocket in the U.S., full price - you are paying much more than you should ever owe. So your argument falls flat as a pancake. As to government subsidies - medical school costs are driven by more than the raw cost of education, they are a profit center, so it's not a good argument for subsidies of government tax money for private profit. And guess where the government gets the money for these subsidies? That's right. Taxes. I pay taxes, so yes, I paid for those subsidies.

 

kills a child

 

I haven't heard of any cases of cats killing children, but maybe I should try to get out more in that part of the country you seem to live in (stretch-the-dodgy-argument-into-fantasy-land) to check out local reports. 

 

Remarkably, you said (true to your ethic) that you'd refuse the kindness of a stranger willing to give you their kidney, no questions asked.

 

Correction. I didn't say that. I said I wouldn't be bothered by nobody stepping forward to give me a kidney - I don't expect or demand strangers do me favors. I'm quite ready to make a clean exit, if circumstances demand. I'd hate to be a burden. I will not ask or solicit for kidneys or any such voluntary gestures. As to acceptance if offered unsolicited, it would be only the beginning of a process for me: is there someone else who needs that kidney more - for example, someone who is much younger than me (and not a terrible person) and so more deserving; who is the person giving me a kidney - I don't want it from someone who is a terrible person (a Nazi sympathizer, for example), as I want to have as little to do with such people as possible - a moot point, of course, if it comes from an accident victim etc.

 

it seems then you should have waved off the paramedic 

 

Oh, I see we're back to this idiocy. My insurance covered emergency care, including the ambulance. The paramedic wasn't acting out of the kindness of his stranger's heart. He was fulfilling his part of the contract. I paid for that contract with my premiums. Why would I wave off services I paid for? And why would the paramedic break his contract?

 

You said yourself compliance with an unjust law is no excuse.

 

Contract law is not unjust.

 

And it is voluntary. The paramedic is not compelled by law to become a paramedic. He volunteers to become a paramedic in exchage for contractually guaranteed compensation for his labor. I paid my part of the contract, now he fulfullis his. Nothing unjust in this. 

 

he should have left you to die

 

But it wasn't up to him. He wasn't a stranger doing me a favor, like a kidney donor. He was contractually obligated to do his job. A contract he voluntarily agreed to. I paid for my part of the contract and I can expect him to do his part. I did not sign a contract to sell my kidney and nobody can expect me to live up to a non-existant contract, just because Dean's silly argument doesn't work otherwise. 

 

wife/kidney/husband etc. nonsense

 

Let me introduce you to a concept that is in operation every day in emergency services among others. It's called "Triage". This is a concept you appear to be completely unfamiliar with, yet it plays a prominent role in all medical decisions on both a macro (societal) and individual level of practice. I say you seem to be unfamiliar with, because you reject it completely out of hand - as you do, when you object to the very concept of vetting individuals for medical services and donated goods such as kidneys because "we're all part of a web of strangers society" handwaving. In reality, the concept of triage is particulary prominent in the organ transplant domain of medical care. My point is very simple - it is the extension of the concept of triage to the supply side of the transplant medicine. People do that anyway already, when they decide to or not to donate to relatives, friends or strangers. So do I - it's no different. I just happen to have a criterion for my triage that bothers you - I care about who the recipient is. That remains true, whether I'm at the receiving end of it, or giving end, it is true for my relatives, friends and wife too. There is triage involved anyhow.

 

In our modern world we are inextricably intertwined with a multitude of strangers.

 

Trite generality alert!

 

Just because we are intertwined does not mean that we are all compelled to the same range of actions no matter the priority, cost or outcome. Buying kale from a pedofile is not going to have far-reaching consequences, and selling greens to a serial killer likewise. Losing a kidney will. Therefore, one should take great care when making decisions about the kidney - or any high priority item - and spend less to no time on inconsequencial decisions. Who would've thunk, huh, Dean? But by all means, if you think a decision about kale is equivalent to losing a kidney, and therefore we should not vet anyone ever for anything, I look forward to the world of Dean, where means-testing and triage on scales large and small are abolished completely and we live forever in Dean's Consequence Free Fantasy Land.

 

Meanwhile, back here on planet earth:

 

It seems to me you are being hypocritical by espousing it while benefiting from all the good things strangers have done for you.

 

LOL! I guess this is final "conclusion" step after the missing one of ???? - the question marks indicating how it obviously doesn't need any supporting evidence. A lot of contradictory and counterfactual drivel and then presto - a "conclusion"!

 

Oh, Dean, never change - keep the fantasy world spinning!

 

Thomas G:  We do not have a scarcity of kidneys!

 

Possibly on Mars. Down here on earth, the opposite is true. I'm not going to spend a lot of time explaining why far from artificial, the shortage is very, very real, but please note that one reason why the scarcity exists is that people are cognizant of the significant cost to donating a kidney. If you are unaware of such a cost, please peruse the medical literature - basing an argument or worldview on false information does not lead to workable solutions.

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Donating your kidney would be considered a preexisting condition, potentially increasing your health insurance premiums or having health insurance denied outright.

 

This is so bone-headed and cruel. Given that kidney donation makes health insurance cheaper for everyone, because it removes the extraordinary costs of keeping people on dialysis, this is just stupid economically as well as medically. It also makes sure no good deed will go unpunished.

 

I want to donate my kidney. Obamacare repeal would make that a little scarier.

 

 

Preexisting conditions are often thought of in two ways: They’re either conditions someone couldn’t prevent or they’re conditions a person brought on themselves via irresponsible behavior. I take issue with the latter characterization (see: Aaron Carroll at Vox), but this is how discussions on preexisting conditions are generally framed.

But kidney donations show there’s another possibility: Maybe a person brought the condition on themselves through good behavior. And now they might be penalized for it.

This is obviously absurd. It’s effectively punishing people for doing something that’s unquestionably good, something that’s literally saving another person’s life. But it’s how the system works.

 

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One thing that I didn't know before, and that I would like to learn more about, is that people who donate a kidney can't take aspirin anymore. I wonder why that is. It also gives me pause since aspirin might be pretty beneficial. I don't currently take a baby aspirin, but after watching that interview with Judith Campisi I wonder if it could be useful to suppress low-grade inflammation.

 

Lifelong aspirin supplementation as a means to extending life span.

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Thomas,

 

Aspirin and other NSAIDs (e.g. ibuprofen) are cleared through the kidney and are thought to put strain on the kidney if used chronically. That is why kidney donors are warned against using them regularly. Acetaminophen (aka Tylenol) is cleared by the liver and is the preferred analgesic for kidney donors.

 

--Dean

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Organ Donation is a good thing.I dont know why some people restrict donating organs.Kidney transplant is done for who has lost over 85% of the function of his/her kidneys. At this stage patient cannot lead a comfortable life with medications alone ; the patient should undergo kidney transplantation surgery , if he/she is medically fit for the procedure.The donor can be either a living person or a person who has had a brain death. The living donor has to be a healthy person above the age of 18 years and below 60 years, and should have two normally functioning kidneys ; he/she should not have any medical illness which makes him/her a high risk for anesthesia and surgery. The medical fitness for kidney donation can be find out after a detailed medical evaluation.For more refer http://astermedcity.com/CentresOfExcellence/KidneyTransplant/C236/kidney-transplant . By organ donation we can save life.It is a holy thing.

Edited by jamesannie

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Wondering if anyone has any thoughts about living liver donation?   My wife's cousin needs a liver transplant, and apparently no one else among her relatives is both qualified as a living donor, and has A+ blood type except for my wife.  She wants to do it.  It makes me nervous.  Looking into the stats, it seems liver donation may be less risky than kidney donation. Risk of death for the donor is 1 in 300, liver should just grow back, but they also have to remove the gall bladder as part of the procedure (not something I would voluntarily want to do, having had mine removed already, but I guess not the end of the world either).  Requires a one week hospital stay and up to 8 weeks recovery, fatigue for up to 3 months.  In my research, it looks like about 25% of people waiting for a liver transplant die while waiting.  Flip that around and I guess you could say she has pretty good odds, 75% chance of getting a donor liver without my wife having to do it, if she just waits.  I'm told she is #18 on the list to receive a transplant, which is pretty high priority (moved up this week after being hospitalized in extreme pain).   Her cousin is pretty young (30's), doctors aren't sure what caused the liver failure (she does not drink, and does not have hepatitis, those are the two main causes of liver disease generally). Not really sure if, without knowing the cause, the transplanted liver would also be likely to fail? 

What would you do in this situation?  It's a difficult decision from my perspective, but my wife has no hesitation about it, she wants to proceed and just considers it almost like an obligation to do what she can to help her cousin.

 

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I'd be nervous too, but it's really your wife's decision, unless there is a significant and likely impact on you.

I don't know if I can do it, personally. I am not brave enough, barely able to face a simple blood draw.

Anyway, my hat off to your wife.

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Gordo,

It's a very personal decision, but solid organ donation is an awesome way to help someone in need. Great of your wife to be considering it. It is one of the only ways an average person can be almost guaranteed to save someone's life.

One correction:

25 minutes ago, Gordo said:

Looking into the stats, it seems liver donation may be less risky than kidney donation. Risk of death for the donor is 1 in 300...

While the mortality risk for liver donors is indeed estimated to be about 1 in 300, that is substantially more risky than kidney donation, which has an estimated mortality rate of less than 1 in 10,000. 

--Dean

 

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12 hours ago, Dean Pomerleau said:

While the mortality risk for liver donors is indeed estimated to be about 1 in 300, that is substantially more risky than kidney donation, which has an estimated mortality rate of less than 1 in 10,000. 

Thanks for that clarification, what I was really thinking but didn't write was that it seemed like based on what I've read, the longer term health risks post procedure for surviving donors are lower from a liver donation vs. kidney (i.e. The liver grows back and you are good to go, vs. missing a kidney and making your other one work harder and having higher risk of complications because of that). 

As for the impact on me from my wife donating a liver... I guess I'd just have to take care of her for several weeks and cancel the travel we have booked but that seems petty and insignificant in the grand scheme.  In the unlikely event that she were to die or suffer long term injury the impact would be huge (we have two grade school kids, she also is the one in the family with a steady job, health insurance, and a pension, while I am the self employed one with no benefits). 

I wonder if you can buy a few million in life/disability insurance before the procedure and cancel it afterwards if all goes well?  Maybe that would at least mitigate the financial risk aspect. 

I know at the end of the day saving a life takes precedence and its what I would hope someone would do for us, so it makes sense to do it. I support her in it. I would do the same. If I could start a donation chain maybe I could even take her place (assuming a matching donor in the chain could help her cousin, as I don't have the right blood type). 

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2 hours ago, Gordo said:

based on what I've read, the longer term health risks post procedure for surviving donors are lower from a liver donation vs. kidney (i.e. The liver grows back and you are good to go, vs. missing a kidney and making your other one work harder and having higher risk of complications because of that). 

You are right the liver regenerates and the kidney doesn't. Risk of death and serious complications is a lot higher with liver in the first six months after donating, but longer term being down a kidney poses its own unique risks. These risks are mostly mitigated for people who donate via the National Kidney Registry though. The NKR promises all its donors that they will go to the top of the list to receive a living donor kidney should their remaining kidney ever stop functioning properly. There is no equivalent backstop for liver donors. 

Liver donors also loose their gallbladder in the transplant process, which you know has its own associated risks. Plus the liver doesn't  completely regenerate - you can't donate your liver again once you've recovered from liver donation since the blood vessels supplying the donated portion of your liver don't grow back. 

2 hours ago, Gordo said:

I wonder if you can buy a few million in life/disability insurance before the procedure and cancel it afterwards if all goes well?  Maybe that would at least mitigate the financial risk aspect

Maybe, as long as you disclose her upcoming surgery. Again here is a place where kidney donation has an advantage, at least through the NKR. The NKR automatically offers all its donors $1M in life and disability insurance for one year to cover just such a risk, although as far as I know, nobody has every had to cash it in among the ~4000 NKR-facilitated donations.

2 hours ago, Gordo said:

I would hope someone would do [it] for us, so it makes sense to do it.

I like that attitude. Just don't let Tom hear you expressing it :-). Speaking of Tom, I wonder what has happened to him. He hasn't posted in ~5 months. I tried emailing him a couple weeks ago and haven't heard back. I hope he's ok.

2 hours ago, Gordo said:

I could start a donation chain maybe I could even take her place (assuming a matching donor in the chain could help her cousin, as I don't have the right blood type). 

That would technically be a swap or a loop. Chains, swaps and loops aren't done often in livers (unlike kidneys where they are done all the time). But I've heard UPMC in Pittsburgh has recently started doing liver chains and loops. That might be a possibility for you since you live in Pennsylvania.

Optimally your liver would be a match for someone whose incompatible donor matches your wife's cousin. You would then basically swap donors between the two incompatible pairs.

Good luck, and let us know what you and your wife decide!

--Dean

 

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