Will divorce become legal in the Philippines?

  The NYT has the story:

‘Just Like Medicine’: A New Push for Divorce in a Nation Where It’s Illegal.  A campaign in the Philippines that frames divorce as a basic human right is gaining momentum, despite systemic and religious barriers.  By Sui-Lee Wee

"Thousands of people like Ms. Nepomuceno are trapped in long-dead marriages in the Philippines, the only country in the world, other than the Vatican, where divorce remains illegal. 

...

"Partly because of their growing numbers and plight, attitudes in the country, where nearly 80 percent of the population is Catholic, have changed. Surveys show that half of Filipinos now support divorce. Even the president has signaled openness to the idea, and the Philippines is the closest it has ever been to legalizing divorce.

"But the issue is far from settled. The powerful Catholic Church has deemed pro-divorce activism to be “irrational advocacy.” Conservative lawmakers remain steadfast in their opposition.

"This has prompted some in the legalization camp to frame divorce as a basic human right, like access to health care or education.

...

"In recent months, a Senate committee approved a bill on divorce for the first time in more than 30 years. The bill is now awaiting a second reading in the Senate, which lawmakers say could happen next year.

...

"Divorce has a complicated history in the Philippines. During the Spanish colonial era, divorce was banned, but legal separation was allowed under narrow conditions. Under American occupation, it was made legal, but only on the grounds of adultery and concubinage. The Japanese, who occupied the Philippines during World War II, expanded the divorce law, allowing more grounds for people to seek divorce.

"That changed after the enactment of the country’s Civil Code in 1950. But Muslim citizens, who make up 5 percent of the population, are allowed to divorce, because in 1977, Ferdinand E. Marcos, the president at the time, signed legislation allowing it.

...

"A decade ago, when the Philippine Congress passed legislation that gave people access to contraception, the clergy held protests and threatened to excommunicate lawmakers for supporting the bill. This time, said Edcel Lagman, a congressman who has pushed for both issues, church officials have been less vocal in its opposition."

Surrogacy guidelines: necessity, not convenience

 As surrogacy becomes increasingly well established in the U.S., it is regulated not only by state laws, but  also via voluntary standards put forward by trade organizations as conditions of membership.

One is  the SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY (SEEDS), which calls itself "a nonprofit organization founded by a group of egg donation and surrogacy agencies, whose purpose is to define and promote ethical behavior by all parties involved in third party reproduction." 

They have a set of guidelines published this year which member organizations are supposed to subscribe to.  One of those guidelines seems to say that surrogacy agencies should only work with intended parents who can't have children on their own. That is, they want to facilitate surrogacies that they regard as necessary rather than those that might be merely convenient.

SOCIETY FOR ETHICS IN EGG DONATION AND SURROGACY, STANDARDS of ETHICAL CONDUCT for SEEDS MEMBER AGENCIES

"24.Agency Screening of Intended Parents

"a. An Agency shall not provide service to Intended Parents unless they demonstrate a need for surrogacy associated with a disease, condition or status characterized by:

"i. the failure to establish a pregnancy or to carry a pregnancy to live birth after regular, unprotected sexual intercourse;

"ii. a person’s inability to reproduce either as a single individual or with their partner without medical intervention; or

"iii. a licensed physician’s or mental health professional’s findings based on a patient’s medical, psychological, sexual, and reproductive history, age, physical findings and/or diagnostic testing. 

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The legal blog Above the Law has a post about this:

Should 'Social Surrogacy' Be Permitted? by Ellen Trachman

It says in part:

"What does the law say? States like Louisiana and Illinois specifically require documented medical need of intended parents in a surrogacy arrangement to comply with the state surrogacy law. Louisiana requires that a doctor “who has medically treated the intended mother … submits a signed affidavit certifying that in utero embryo transfer with a gestational carrier is medically necessary to assist in reproduction.”

"Utah previously required “medical evidence … show[ing] that the intended mother is unable to bear a child or is unable to do so without unreasonable risk.” But that provision was struck down by the State Supreme Court after determining it was unconstitutional as applied to a same-sex male couple and could not be read a in gender-neutral way. (The SEEDS standard is, by contrast, gender neutral.)

"Other states with surrogacy-specific statutes — like California, Washington, Colorado, New Jersey, and New York — are silent on medical need and, therefore, implicitly permit social surrogacy arrangements. And then those states with no surrogacy law, much of the country, permit social surrogacy by default.

"The SEEDS standard, of course, only applies to member agencies and does not prevent nonmember agencies from supporting social surrogacy arrangements or for those arrangements to occur independent of agencies."

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Stephanie Wang and I anticipated to some extent that this could be an issue in our paper

Roth, Alvin E. and Stephanie W. Wang, “Popular Repugnance Contrasts with Legal Bans on Controversial Markets,” Proceedings of the National Academy of Sciences (PNAS),  August 18, 2020 117 (33) 19792-19798.

We surveyed populations in the U.S. and several other countries on transactions that were legal in some of them and illegal in others. We presented vignettes, and asked if they should be legal.  Because we wanted to give surrogacy a good chance of being perceived as repugnant, we made clear in the surrogacy vignette that there was no medical necessity, it was sought for convenience:

"James and Erica are a married couple in [home country]. They want to have a child, but Erica does not want to become pregnant due to the demands of her career as a model. Maria is a married mother in the Philippines. Maria’s husband is out of work, and Maria has decided to become a surrogate mother to earn additional income. James and Erica hire Maria to carry and give birth to a child from James and Erica’s sperm and egg. James and Erica pay Maria a year’s average income in the Philippines, and everyone signs a contract making it clear that James and Erica are the child’s biological parents and will have custody after the child is born."

You can see in the paper (or in this 2020 blog post) that (even) under these circumstances, clear majorities favored making this kind of voluntary surrogacy legal, not only in the U.S. and Philippines where surrogacy is legal, but also in Spain and Germany where surrogacy is illegal.

Surrogacy and global kidney exchange receive popular support even where banned, in PNAS by Roth and Wang

Popular repugnance contrasts with legal bans on controversial markets
Alvin E. Roth and  Stephanie W. Wang
PNAS first published July 29, 2020 https://doi.org/10.1073/pnas.2005828117

reviewed by Nicola Lacetera and Mario Macis

Abstract: We study popular attitudes in Germany, Spain, the Philippines, and the United States toward three controversial markets—prostitution, surrogacy, and global kidney exchange (GKE). Of those markets, only prostitution is banned in the United States and the Philippines, and only prostitution is allowed in Germany and Spain. Unlike prostitution, majorities support legalization of surrogacy and GKE in all four countries. So, there is not a simple relation between public support for markets, or bans, and their legal and regulatory status. Because both markets and bans on markets require social support to work well, this sheds light on the prospects for effective regulation of controversial markets.

"Our main result is that (unlike prostitution) the laws banning surrogacy and GKE do not seem to reflect popular demand. Neither do these bans reflect that opponents of legalization feel more strongly than supporters.

...

"All three transactions are the subject of current debate in at least one of the countries we surveyed.¶¶ Based on the results of our surveys, we do not see entrenched popular resistance to either surrogacy or GKE (or simple kidney exchange) where it is presently illegal, and thus, we anticipate that efforts to lift or circumvent current restrictions are likely to be increasingly successful, while efforts to legalize or decriminalize prostitution where it is presently illegal may face greater opposition from the general public.

"Understanding these issues is important, not just for the hundreds of Spanish couples stranded outside of Spain while they look for a way to bring their surrogate children home and not just for the people in need of kidney exchange but for whom it is out of reach in Germany or in the Philippines. These issues are also of importance to social scientists in general and economists in particular. When markets enjoy social support, when they are banned, and when, in turn, bans are socially supported are questions that touch upon many transactions, particularly as social and economic interactions are increasingly globalized.

"Our findings suggest that the answer to these questions may not be found in general public sentiment in countries that ban markets or legalize them. Rather, we may have to look to the functioning of particular interested groups, perhaps with professional or even religious interests, that are able to influence legislation in the absence of strong views (or even interest) among the general public about the markets in question."

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Here's the published citation:

Roth, Alvin E. and Stephanie W. Wang, “Popular Repugnance Contrasts with Legal Bans on Controversial Markets,” Proceedings of the National Academy of Sciences (PNAS),  August 18, 2020 117 (33) 19792-19798; https://doi.org/10.1073/pnas.2005828117 

Global kidney exchange: followup report on the first GKE chain

Here's a report, 3 years after, of the first global kidney exchange chain. Among the authors are the Filipino physicians who are providing ongoing care for the Filipino donor and recipient:

Complete Chain of the First Global Kidney Exchange Transplant and 3-yr Follow-up

Author links open overlay panelDanielle N.BozekabTy B.DunncChristian S.KuhrdChristopher L.MarsheJeffreyRogersfSusan E.ReesbLauraBasagoitiagRobert J.BrunneraAlvin E.RothhObiEkwennaabDavid E.FumoabKimberly D.KrawieciJonathan E.KopkebPuneetSindhwaniaJorgeOrtizaMiguelTanjSiegfredo R.PaloyoklJeffrey D.PunchmMichael A.Reesab

https://doi.org/10.1016/j.euf.2018.07.021Get rights and content

European Urology Focus

Available online 23 August 2018

In Press, Corrected ProofWhat are Corrected Proof articles?

Abstract

Background

Global Kidney Exchange (GKE) offers an opportunity to expand living renal transplantation internationally to patients without financial means. These international pairs are entered into a US kidney exchange program that provides long-term financial support in an effort to identify opportunities for suitable exchanges for both these international pairs and US citizens.

Objective

While the promise of GKE is significant, it has been met with ethical criticism since its inception in 2015. This paper aims to demonstrate the selection process and provide >3 yr of follow-up on the first GKE donor and recipient from the Philippines.

Design, setting, and participants

The first GKE transplant occurred with a young Filipino husband and wife who were immunologically compatible, but lacked the financial means to continue hemodialysis or undergo a kidney transplant in their home country. The pair was enrolled in the Alliance for Paired Donation matching system, several alternative kidney exchanges were identified, and the pair subsequently underwent renal transplantation and donation in the USA financed by philanthropy. The resulting nonsimultaneous extended altruistic chain provided transplantation for the Filipino husband and 11 US patients.

Outcome measurements and statistical analysis

The Filipino donor and recipient were followed by transplant professionals in both the Philippines and the USA. Follow-up data were maintained as required by the Organ Procurement and Transplantation Network in the USA.

Results and limitations

The Filipino donor has normal blood pressure and renal function, and the Filipino recipient is doing well 3.5 yr after their donation and transplantation.

Conclusions

While criticisms of GKE highlight concerns for possible exploitation of financially disadvantaged groups, these results demonstrate that these concerns did not come to fruition, and the outcome experienced by the GKE donor and recipient (and other US participants) was successful.

Patient summary

The first Filipino Global Kidney Exchange (GKE) donor-recipient pair continues to be followed by both US and Filipino transplant centers. Both are in good health, support the GKE program, and advocate for its expansion.

An unexpectedly repugnant transaction: singing "My Way" in the Philippines

A NY Times story on karaoke in the Philippines is full of interesting and unexpected detail: Sinatra Song Often Strikes Deadly Chord "The authorities do not know exactly how many people have been killed warbling “My Way” in karaoke bars over the years in the Philippines, or how many fatal fights it has fueled. But the news media have recorded at least half a dozen victims in the past decade and includes them in a subcategory of crime dubbed the “My Way Killings.” " ... [While Karaoke sometimes leads to violence elsewhere] "the odds of getting killed during karaoke may be higher in the Philippines, if only because of the ubiquity of the pastime. Social get-togethers invariably involve karaoke. Stand-alone karaoke machines can be found in the unlikeliest settings, including outdoors in rural areas where men can sometimes be seen singing early in the morning. And Filipinos, who pride themselves on their singing, may have a lower tolerance for bad singers. Indeed, most of the “My Way” killings have reportedly occurred after the singer sang out of tune, causing other patrons to laugh or jeer. “The trouble with ‘My Way,’ ” said Mr. Gregorio, “is that everyone knows it and everyone has an opinion.” Others, noting that other equally popular tunes have not provoked killings, point to the song itself. " ... "Defenders of “My Way” say it is a victim of its own popularity. Because it is sung more often than most songs, the thinking goes, karaoke-related violence is more likely to occur while people are singing it. The real reasons behind the violence are breaches of karaoke etiquette, like hogging the microphone, laughing at someone’s singing or choosing a song that has already been sung. “The Philippines is a very violent society, so karaoke only triggers what already exists here when certain social rules are broken,” said Roland B. Tolentino, a pop culture expert at the University of the Philippines. But even he hedged, noting that the song’s “triumphalist” nature might contribute to the violence." ... "But in karaoke bars where one song costs 5 pesos, or a tenth of a dollar, strangers often rub shoulders, sometimes uneasily. A subset of karaoke bars with G.R.O.’s — short for guest relations officers, a euphemism for female prostitutes — often employ gay men, who are seen as neutral, to defuse the undercurrent of tension among the male patrons. Since the gay men are not considered rivals for the women’s attention — or rivals in singing, which karaoke machines score and rank — they can use humor to forestall macho face-offs among the patrons. In one such bar in Quezon City, next to Manila, patrons sing karaoke at tables on the first floor and can accompany a G.R.O. upstairs. Fights often break out when customers at one table look at another table “the wrong way,” said Mark Lanada, 20, the manager. “That’s the biggest source of tension,” Mr. Lanada said. “That’s why every place like this has a gay man like me.”"

Black market kidney sales in the Phillipines

Last Friday I was part of a panel at Harvard at the National Undergraduate Bioethics Conference , at which a panel consisting of me, Frank Delmonico, and Nir Eyal, and moderated by Dan Brock, was asked to consider the question "Should willing sellers be permitted to sell body parts to willing buyers?".

Among other things, I defended the point that the performance of a potentially regulated legal market can’t be well predicted from the performance of unregulated, illegal markets. Frank largely disagrees with that, and expects that any regulation short of attempting to ban organ markets outright will inevitably deteriorate into the kinds of illegal markets we see in some parts of the developing world. Regardless, it's good to pay attention to the black and grey markets around the world. Here's an account of such a market in the Phillipines: No Turning Back. Some aspects of this market are quite black (the subject of the story is threatened with retribution if he changes his mind once medical tests have been paid for), and some are grey (quite a few medical tests are done, although perhaps not to the standard we would like), and some are not even so grey (the subject of the story is paid, and gets a motor vehicle and a house out of it, and would do it again).

"Lito, 23, a resident of Gumaca, Quezon, who sold one of his kidneys, knew the stakes just got higher when he was told before the transplant procedure that he could not back out anymore. A friend of his decided to pull-out. “They are hunting him down. They want to have him killed." ... "On February 14, 2007, the friend accompanied Lito to a house in Barangay Tikalan, a village in San Juan, Batangas where a man named “Junior” who was referred to by his men as the “manager,” housed other would-be donors.“Junior” is also an organ donor. The following day, Lito and nine others were brought to a private hospital laboratory in front of the National Kidney and Transplant Institute (NKTI) where many people were having their blood samples taken. They also underwent a number of tests. X-rays were also taken. Junior paid for the procedures. " ... "For over a month after the first tests, Lito shuttled back and forth from Batangas to Metro Manila in order to undergo various tests in different hospitals. In each of the trips, he was accompanied by either “Junior” or one of his men. The purpose, he was told, was to look for a match. ... "Back home in Gumaca, Lito found that money has a way of slipping easily between one’s fingers. In his case, it lasted only for six months. Almost half of the amount he got from selling his kidney—about P40,000—went to the payment of debts. With the rest of the money he was able to buy a tricycle and a small dwelling. Months later, however, he had to pawn the tricycle to pay for his daughter’s hospitalization. Lito does not regret going through the operation. “I was in dire straits,” he explained. If he did not go through it, he said, he would not have been able to pay his debts. Besides, he said, he did it for his family’s sake. “I am ready to give up my life, for the sake of my family.” "