Fundraising and the Delayed Kidney Transplantation: A Loophole in the Ban against Commercialization?

In April, a kidney donation from an unrelated living donor was put on hold in South Portland, Maine. The reason was unusual: the generosity of the community.  In response to an online fundraising for the donor, 768 people contributed over $49,000—well beyond what can reasonably be called “compensation.” The hospital thus had to ask the question: Is the donation procedure in conflict with the law now that the donor stands to profit from it? After initial media coverage, there was no further news about this case. On Monday, however, it was announced on the fundraising page that the transplant is back on track and due to happen in two weeks. Does that mean that we now have a loophole in the ban against commercialization of organs?

The case is unprecedented. There are and have been other online fundraisers to compensate donors. But this is the first time that the unpredictable powers of the internet kicked in (remember the guy who raised $55,000 to make a potato salad?). The law prohibits any monetary payments to organ donors. The situation poses two questions: What should be done in this particular case, and how should fundraising for organ donors be regulated going forward?

It appears that the first question was somehow resolved even though we don’t know how: Did the hospital decide it was not a problem after all, or did the donor agree with the hospital’s reported initial suggestion of donating the “excess” money to some other organization? In either case, what follows remains problematic.

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What Should Customers Do About Dirty Practices of Big Companies?

The video “Who Pays the Price? The Human Cost of Electronics” recently went viral on social media. It purports to document the suffering of former workers of Chinese electronics factories that supply smartphones to big brands. According to the video, these workers contracted serious occupational illnesses such as cancer and severe nerve damage as a result of exposure to the toxic chemicals benzene and n-hexane. The workers are said to be unaware of the fatal risks; and in any event, many would be too young to consent. The film calls for elimination of toxic chemicals in electronics factories, which it claims can be done at a negligible cost.

Watching this video and learning about this problem, are we, the customers, now under a duty to act?

For instance, in an effort to convince Apple to remove toxic chemicals from their factories, the “Bad Apple” campaign asks customers to sign a petition, call the brand, and maybe re-consider upgrading their phone less often. The campaign targets Apple because of its powerful position in the public eye as well as in the industry, which currently lacks any toxin-free option.

The question is: What is the morally right response of a customer? To put it in more detail, are you morally required to take action? If so, is signing the petition or calling the brand sufficient or should you, for example, boycott the brand?

Here is the answer: You are probably right to do anything, including nothing. Continue reading

Is Turkey’s Health Systems Reform as Successful as It Sounds?

In July, the Lancet covered Turkey’s development and implementation of universal health coverage extensively in an article and in supplementary comments. The main article, written by those who are directly involved in the development of the health systems reform (including the former Health Minister), presents a success story. Within Turkey, however, the success of the reform has been disputed. Two points in particular are being repeated by the Turkish Medical Association (TTB), doctors, and journalists: the negative effects of the reform on (1) the quality of health care personnel and (2) privacy.

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What Is (Not) Wrong With Doping – Part II

[In part I, I considered, and rejected, arguments that doping harms the athletes and treats human nature wrongly.]

Spirit of sport

Let us now turn to the third objection: the use of PEDs destroys the spirit of sport. Of course, “spirit of sport” is a rather nebulous concept. Here is what the WADA has to say about it:

The spirit of sport is the celebration of the human spirit, body and mind, and is characterized by the following values: Ethics, fair play and honesty; health; excellence in performance; character and education; fun and joy; teamwork; dedication and commitment; respect for rules and laws; respect for self and other participants; courage; community and solidarity. Doping is fundamentally contrary to the spirit of sport.[1]

Even if one agrees with this not-very-useful definition, it remains a mystery how the WADA deduces that doping (if allowed) is contrary to this spirit so defined.

I think it is better to put the WADA’s statement aside and see if there can be a better use of this concept of the “spirit of sport.” To demystify it, one may ask two questions: what is the purpose/aim of professional sports, and why do we cheer for an athlete. Once we clarify what we mean by the spirit of sport, we can inquire how doping corrupts this spirit.

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What Is (Not) Wrong With Doping – Part I

Sports news has a permanent section now: the doping news. Less than a month ago, Gay and Powell (“the second and the fourth fastest men of all time”) also tested positive for banned substances. What used to be a scandalous piece of news (maybe with its final anti-hero being Lance Armstrong) became more of a curiosity item. The problem of doping became so wide-spread (tainting even curling!) that it is casting doubt on every medal we have ever seen in sports history. The war against doping seems to be a failure and even those who previously fought against doping now start to re-consider their views.[1]

Under the current rules, the ethical problem with doping is obvious: fairness. Those who cheat the system have an unfair advantage. However, the cheating argument is valid only when doping is prohibited. If the use of performance enhancing drugs (PEDs) were allowed, there would be no cheating since every sportsperson would be equally entitled to use them.[2]

Then, why not just allow doping?

Three objections are common:
1. It is dangerous/harmful for the athletes.
2. It treats human nature wrongly.
3. It violates the spirit of sports.

None of these objections are strong.

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Some Thoughts on Sandel’s “What Money Can’t Buy”

Last Wednesday, I went to Michael Sandel’s lecture introducing his new book What Money Can’t Buy: The Moral Limits of Markets. His talk focused on two main arguments: There should be certain norms that govern our relationship with certain goods; and markets corrupt these norms.

I think Sandel’s position fails in three respects:

  1. The book does not provide a theoretical basis for these norms. In other words, the book does not explain where these norms come from, which norms are suitable for which relationships, or how they are violated.
  2. Given the lack of theoretical basis, the book cannot identify a stopping point for its suggestion to preserve and cultivate virtues related to these norms. There would seem to be many more activities to which the book’s suggestions could be expanded, yet even Sandel does not seem willing to go there. To the extent one accepts it, Sandel’s argument thus proves too much.
  3. Instead of presenting a theoretical basis, the book proceeds by analogy. But the analogies seem unconvincing in that their source and target situations seem materially different.

Let me flesh out these points.

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To Tell or Not to Tell: Should Researchers Contact Anonymous Donors to Help Them?

A recent New York Times article drew attention to an issue with increasing importance as technology develops. Gene samples collected under conditions of anonymity reveal more and more information that may be of crucial importance for the subjects or their relatives. Researchers feel a moral obligation to disclose these important findings, which may even be life-saving, to the subjects. Yet, the anonymity clause in the consent forms prevents them from doing so.

Whether or not researchers can or must disclose the information in spite of the anonymity clause mainly turns on two issues: the scope of the informed consent and the reach of the obligation for beneficence.

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