The USFG should permit the use of financial incentives to encourage organ donation
Seeing as I agree with organ transplantation expert Francis Delmonico, I strongly negate this resolution.
Resolved: The United States Federal Government should permit the use of financial incentives to encourage organ donation.
Financial Incentive: Monetary benefit offered to consumers, employees, and organizations to encourage behaviors or actions that otherwise would not take place. (the Business Dictionary)
Organ donation: the surgical process of providing one or more organs to be used for transplantation into another person. (organdonor.gov)
Asset: Property owned by a person or company, regarded as having financial value (Merriam Webster)
Contention one: Using financial incentives for Organ Donation causes the commodification of the Human body.
Financial Incentives do not necessarily mean a direct cash exchange will occur for organs; however they are still assigned a monetary value, which makes them an asset. If we allow organs to become assets or commodities, that means that others may have a claim to them as Richard Demme states in the Journal of the National Medical Association: "The point is, that if everyone accepts that organs are commodities like anything else that could be bought or sold, then organs could be treated like other things of value that we barter. In such a system, it would be logical that creditors might have a say about what happens to your assets. If you list your organs along with the rest of your assets, others might have a claim on them, and that is morally repugnant."
If we allow organs to become assets or commodities, it is logical to assume that if you owe money to a creditor and they must seize your assets, your organs can be included. Imagine the bank foreclosing on someone who cannot pay their mortgage, and seize their kidney along with their house! Some might argue that the positives of financial incentives (such as the possibility of saving lives due to increased donation) outweigh these evils, but that is not valid, because as the National Kidney Foundation states: "By treating the body as property, in the hope of increasing organ supply, we risk devaluating the very human life we seek to save." While the organ shortage is undoubtedly a major problem, we cannot trade our dignity and possibly even our freedom with our own body to counter it.
Contention two: Financial Incentives will be used improperly.
Sub-point A: Financial incentives will cause the extortion of the poor and disadvantaged.
According to the National Kidney Foundation: "Offering money for organs can be viewed as an attempt to coerce economically disadvantaged Americans to participate in organ donation. Furthermore, since the economically disadvantaged have been shown to be less likely to be organ transplant candidates, financial incentives for organ donation could be characterized as exploitation." Creating a market for organs would allow the wealthy to buy their way to the top of the waiting list, receiving organs that should go to others instead. This problem is not just speculation, it has many historical precedents. For example, prior to the 1994 passing of the "Transplantation of Human Organs act" in India, there existed a free market where organs were bought and sold. The act banned this, because in the market system Indian poor were being exploited and coerced into donating organs. According to the article An ethically responsible approach to increasing the organ donation rate "a financially desperate family that holds a moral objection to organ donation may be coerced by a financial incentive." Allowing exploitation to decrease the organ shortage is unacceptable.
Sub-point B: Financial Incentives will cause organ theft to increase.
As previously mentioned, until 1994 India had a free market organ donation system, and there were many cases of organ theft. One notorious example was the case where "The kidneys of nearly 1,000 unsuspecting people had been removed in a leading city hospital by prominent doctors. The"donors" had been lured with offers of jobs and their kidneys removed under the pretext or removing blood." Another example, in Isreal organs can be bought and sold freely and according to CNN "the Israeli army kidnapped and killed young Palestinians to harvest their organs in the 1990s." When an object has a value attached to it, there are always people willing and able to steal that object for its value, organs are no exception. Yet another example comes from the Republic of Kosovo. In 1999 Kosovo, not yet fully independent, had no laws prohibiting the sale of organs and as a result during the Kosovo war (according to the huffington post) the Kosovo Liberation Army killed 300 ethnic Serb prisoners of war and sold their organs for profit. Atrocities such as these cannot be allowed to happen, and they will happen if we allow organs to be assigned a value, which is why this resolution must be negated.
Contention 3: Financial Incentives are not a viable means to increase organ donation.
According to a poll from the national kidney foundation, 92% of people who refused to donate organs said that financial incentives would not affect their decision in any way. Furthermore, another poll from the Wall Street Journal shows that financial incentives would not increase 68% of Americans willingness to donate organs. In fact only 8% stated that it would greatly increase their willingness. These polls clearly show that financial incentives would only increase organ donation slightly, if at all. However, according to USAtoday: "Arkansas, Georgia, Iowa, Minnesota, New Mexico, North Dakota, Utah and Wisconsin allow tax deductions of up to $10,000 to compensate living donors" these states already provide financial incentives in the form of tax breaks! Are organ donation rates higher in these states? No. in fact, according to information found from the Organ Procurement and Transplantation Network (part of the U.S. health and human services department) the organ donation rates in these states are, on average, 9% LOWER than the rate of the United States as a whole!
Providing financial incentives for organ donation has serious moral implications such as commidification, organ theft, and extortion, and there is strong evidence to prove that they do not even increase the donation rate at all! Since financial incentives provide no benefits, and cause serious moral problems, I strongly urge you to negate this resolution.
In this round, I will present my arguments. In the next round, I will refute my opponents arguments.
I offer the following observation: The Center for Law, Ethics, and Society explains that moral arguments against doing something, even if successful, do not justify banning that something.[i] Additionally, as a result of the clear practical benefits of lifting the current ban on Financial Incentives, the Center concludes that any argument to the contrary could only have bearing on moral, not pragmatic, grounds.[ii] Thus, that some alternatives to financial incentives may exist does not justify the banning of incentives.
Contention 1: The Current System is Racially Discriminatory
The American Journal of Kidney Disease reports that the single largest racial group needing transplants are African-Americans; for kidneys alone, Blacks make up 35% of the demand, despite being only 10% of the Population.[iii] This is disconcerting, as the current donation-based system is formed on racism. Michelle Goodwin of the Health Law Institute explains that to receive federal funding necessary for operation, hospitals must adhere to the OPTN regulations.[iv] Unfortunately, these regulations are based on discriminatory and disproven medical theory. Goodwin furthers that matching antigen markers A, B, and DR are used to determine who may receive an organ for transplantation; it is important to note, though, that these antigens are completely arbitrarily chosen from a pool of hundreds as a means to exclude minorities.[v] The OPTN even admits that the regulations selecting Human Leukocyte antigens are less common in blacks and minorities[vi]. The impact of this is disastrous for minority groups. Dr. Robert Gaston of the University of Alabama concludes that as a result of this unnecessary exclusion, African Americans receive only 1-in-33 Kidneys available for transplant[vii]. Liver patients are as harmed, with the Daily News finding that despite making up greater than 50% of severe liver disease patients, minorities only receive 4% of the transplants.[viii] This is not medically necessary; As Dr. Clive Callender concludes, blacks are medically able to accept organs from 80% of the population.[ix] The UNOS explains that This means that blacks and minorities wait longer than anyone else for organs, and have a greater risk of dying while on the list.[x] By allowing for financial incentives for organ donation, there will be an increased number of available organs for transplant. The VU Law Review explains, that as a free market in organs is formed, discrimination will substantially decline, as the current system is removed.[xi] Accordingly, by allowing for financial incentives, you not only save lives, but also save human rights.
Contention 2: Financial Incentives for Organ Donation would end the shortage, saving lives.
The current shortage of organs for transplantation is explicable in simple macroeconomic analysis. As Professor McConnel explains in his textbook, “Macroeconomics”, when the government sets a price ceiling, or a maximum possible price, it necessarily causes shortages as demand outpaces supply, due to a lack of profitability.[xii] In terms of organ donation, The National Organ Transplant Act set a price ceiling of $0–an organ may be given away, but not sold. As The US Department of Health Explains, this has resulted in nearly 90,000 people in need of organs, but unable to obtain them.[xiii] Fortunately, resolving this problem is a simple matter of allowing supply to meet demand. Professor Kaserman of Auburn University elaborates, using both macroeconomic analysis, and representative sampling of potential donors, a price level of only $1000 per donor would be sufficient to alleviate the current shortage.[xiv] This is because as price level increases, the willingness of those on the margin to donate also increases. This analysis is further supported by The Journal of Economic Literature, which explains that that incentives would enable an additional 20,000 donations per year a minimum, allowing complete solvency of the woes of the state quo in less than five years.[xv] The impact to this is immense. As Professor Wilkinson explains, allowing for a market in organs that corrects current shortages would save or improve the lives of 7.5 Million Americans that would otherwise lie dying in vain at some point in their lives, in the current system’s waiting lists.[xvi]
This economic analysis is proven empirically. Harvard University explains, that “12% of individuals said incentives would make them more likely to donate.”[xvii] This is important because only 0.24% of the 12% would have to donate in order to solve the entire shortage.
Furthermore, the increased donation improves patient outcomes
As Dr. Sally Satel of the Yale School of Medicine explains, because of the current shortage, surgeons have begun using less healthy organs. Faced with a patient on the verge of death, they might transplant, for example, a virus-infected liver from a deceased intravenous drug abuser.[xviii] This is further affirmed by Professor Friedman of NYU Medical Center, who explains that there is greater acceptance of what previously had been termed unacceptable kidneys, now renamed 'expanded criteria donors' from potentially unhealthy donors.[xix] Accordingly, by allowing for a market in organs, both the quantity, and quality, of organs are improved.
[i] Professor Stephen Wilkinson, Keele University, “Bodies for Sale”, Page 103
[iii] Organ Procurement Transplant Network Data, http://optn.org... ( Goodwin pg. 6)
[iv] Budget Omnibus Budget Reconciliation Act of 1986 + Section 1138 of the Social Security Act (Goodwin pg. 97)
[v] UNOS, “Who we Are: Membership: Histocompatibility Labs”, http:// www. Unos.org/whoweare/histolabs.asp (Goodwin pg. 100)
[vi] OPTN/SRTR 2000 Annual Report, iii (Goodwin pg. 102)
[vii] Robert S. Gaston, et al, “Racial Equity in Renal Transplantation: The Disparate Impact of HLA-based Allocation”. (Goodwin pg. 104)
[viii] Kevin McCoy, “Deadly Disparity in Transplants: Blacks and Hispanics deprived”, Daily News. (Goodwin pg. 91)
[ix] Dr. Clive
[x] UNOS Annual Report 2003 (Goodwin pg. 46)
[xi] Michelle Goodwin, DePaul University, In her book “Black Markets: The Supply and Demand of Body parts”
[xii] McConnell, Macroeconomics, “The Law of Supply”, Page 47
[xiii] Organ Procurement Transplant Network Data, http://optn.org... (Goodwin pg. 85)
[xiv] Professor Robert Kaserman, Auburn University, “Markets for Organs: The Question of Supply”, Journal of Contemporary Economic Policy, Vol. 17, No. 2, April 1999, 147-155
[xv] Gary Becker, Professor of Economics @ U Chicago and Fellow @ Hoover Institution. “Introducing Incentives in the Market for Live and Cadaveric Organ Donations”. Journal of Economic Literature. Fall 2007. http://home.uchicago.edu...
[xvi] Professor Stephen Wilkinson, Keele University, “Bodies for Sale”, Page 116
[xvii] William DeJong et al, Professor of Community Health Services, Harvard University, “Options for Increasing Organ Donation”, http://www.ncbi.nlm.nih.gov...
[xviii] Dr. Sally Satel, Practicing M.D., Resident Scholar at AEI and lecturer at the Yale University School of Medicine. “The Waiting Game: The Struggle to Find Organ Donors is More Difficult. April 1, 2006. John Templeton Foundation . http://incharacter.org...
[xix] E. Friedman, Professor @ NYU Medical Center and A. Friedman, Professor @ Yale School of Medicine. "Payment for Donors: Pros and Cons” Kidney International Journal. International Society of Nephrology. Volume 69, pp960-962. February 15, 2006. http://www.nature.com...
Also, before I move on to attack my opponents case I feel the need to point out that the pro is advocating an organ market, involving a direct cash exchange for the transplanted organs. The pro side is not (or has not up to this point) arguing for financial incentives based on tax breaks or anything else, they are only arguing for a market and since both of the Pro sides contentions uphold the idea of an organ market if I prove that an organ market is wrong I win this round because both of his contentions fall.
In the pro's contention one the claim is made that the current organ donation system is discriminatory. I could not disagree more. While I agree that African Americans are under-represented in the current organ donation system I believe it is because of other factors. One of these factors is the fact that 25.8% of blacks are in poverty (http://www.npc.umich.edu...) another is that 19.5% of African Americans have absolutely no health insurance. (http://minorityhealth.hhs.gov...) another reason could be minorities distrust of the largely European American medical establishment. He claims that the regulations put in place by OPTN are "based on discriminatory and disproven medical theory" however my opponent has not provided any source specifically disproving the need for these regulations, only the opinions of a precious few doctors. These regulations are put in place by OPTN and approved by the U.S. Department of Health and Human Services, so until my opponent provides evidence PROVING (not suggesting) that these regulations are "based on discriminatory and disproven medical theory" we can assume that they are valid. Furthermore the fact that these antigens are less common in minorities is merely a sad reality, not discrimination.
Now to move on to the Pro's contention two: he claims that an organ market would end the organ shortage. Firstly, significant evidence indicates otherwise. In fact, financial incentives could even DISCOURAGE donors by destroying the altruism of an organ donation. As pointed out in the article "An ethically responsible approach to increasing the organ donation rate" (I will provide a link if my opponent wishes) "Monetary reimbursement destroys the altruism of the donation process, a component that many donor families find alluring and therapeutic." As I pointed out in my case, there are already states in the U.S. who provide financial incentives, however their donation rates are actually lower than the U.S. as a whole! Another thing we must look at when considering Pro's contention two is the net benefits of an organ market.
Even if we assume that the organ shortage could be completely eliminated, we must look at the implications behind an organ market. By allowing an organ market we are allowing organs to be treated as commodities which is not something we can allow. As I stated in my case, the market system would allow for horrors such as a bank taking a kidney when a person owes them money. As Richard Demme stated in the article "Ethical Concerns About an Organ Market" (will provide a link if my opponent wishes) "No one should have a claim on your vital organs, even if you wish to assign a specific value to them. When our parts are worth more than our persons, we are in a situation where people can be treated as a means to an end, and not an end in themselves." By treating human beings as commodities we can open the doorway to many morally wrong things.
Of course the pro will argue that we are saving lives, but as the National Kidney Foundation states: "By treating the body as property, in the hope of increasing organ supply, we risk devaluating the very human life we seek to save." But there are many ways we could save lives. Perhaps, as Richard Demme states: "Or imagine, we could have a national lottery of all the healthy people in the country, every tenth person would be asked to give up a kidney." this solution would certainly end the organ shortage, but it would result in national outcry and angry because it morally wrong. Another terribly wrong "solution" to this shortage would be to establish "human farms" where we take a group of individuals we do not like and harvest their organs. Imagine all the lives we could save! Two kidneys, a liver, a heart, an intestine, and countless skin grafts from each individual we force into this! Of course such a "solution" is terribly wrong and cruel, and would never, and should never, be allowed. The same can be said for financial incentives.
Before I end this round I would like to thank my opponent for providing a thought provoking and challenging case (and I'm not just saying that for "conduct" points.) and I would like to point out that the organ shortage is temporary. We will find a solution to it, but financial incentives are not the answer. We must not give up our principles to end a temporary problem. Please Negate.
M.Gold forfeited this round.
At the beginning of his case, my opponent offers an observation that "moral arguments against doing something, even if successful, do not justify banning that something." While at first this appears to be a compelling argument, lets examine it closer. I contend that all laws are based on morality, as the Christian Research Institute states: "Because every law springs from a system of values and beliefs, every law is an instance of legislating Morality. ...Those who seek to separate morality from law, therefore, are in pursuit both of the impossible and the destructive. The question before us is never whether or not to legislate morality, but which moral system ought to be made legally binding."
It is immoral to kill thus we have laws against murder. It is immoral to force sexual intercourse, and thus rape is banned. It is immoral to steal, and thus theft is criminalized. The affirmative might state that all those laws have practical and not just moral reasons for their existence, and I would dispute it. However lets assume for a moment that that response is valid. Using the Pro's quotes all of these things would have to be legalized, because the only arguments against the are moral: Child-Adult intercourse, incest, bestiality, prostitution, necro-prostitution, gambling, animal cloning, human cloning, polygamy, and many other issues. Even if you believe that one or more of these issues SHOULD be legal, the Pro's statement only stands if ALL of these should be legalized.
Pro's contention one has already been negated. He has not demonstrated how the antigen markers are unnecessary. Like I stated in the previous round, the fact that minorities are less likely to have these antigens is the unfortunate reality.
Pro's contention two also falls because it is advocating an organ market. I have shown both in my case, and my rebuttal how an Organ Market is wrong and this has gone undisputed. I have also shown in my Contention Three that other forms of financial incentives do not work. Even if we assume that an Organ Market can solve the organ shortage, there are other ways to solve this crisis without the moral implications that come with an organ market, like required response.
Pro also states in his contention two that the quality of donated organs would increase. This is false, because the vast majority of those donating for financial incentives would undoubtedly be the poor, who are generally less healthy than the average American because of their lack of health insurance. Also studies have found links between poverty and kidney failure so the kidneys donated by the poor are far more likely to be worse in quality than those currently donated so that advantage is negated.
All of my arguments still stand unrefuted.
Since I have thoroughly attacked my opponents contentions and he has yet to raise any objection against mine, the con side clearly wins this debate. Thank you.
Sources used in this rebuttal:
M.Gold forfeited this round.
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