Showing posts with label compensation for donors. Show all posts
Showing posts with label compensation for donors. Show all posts

Thursday, March 27, 2014

Northwestern football players granted the right to form labor union

Here's the story: College Players Granted Right To Form Union

"CHICAGO — In a decision that has the potential to fundamentally reshape the N.C.A.A. and alter the relationship between universities and their athletes, a regional director of the National Labor Relations Board sided with a group of Northwestern football players Wednesday, calling them employees who have the right to collectively bargain."

Here's the link to the NLRB page with the decision 

The parties have until April 9, 2014 to file with the Board in Washington, D.C. a Request for Review of the Decision.

Here's my post from Sunday with background.

Saturday, March 22, 2014

Timothy Taylor discusses the debate on whether selling a kidney should be legal

At his blog Conversable Economist, Timothy Taylor gives a nice summary of the arguments in the recent debate in the Journal of Medical Ethics that I posted about here.

Selling a Kidney?

He concludes:
"My sketch here cannot do justice to all of the arguments involved, but I will add two points. First, at present, the main source of kidney donations is people who die unexpectedly, with a few voluntary donors. In the meantime, thousands of Americans die every year awaiting a kidney transplant. I can easily imagine that a substantial group of healthy people might not be willing to donate a kidney for free, but would be willing to do so for substantial compensation, and encouraging transplants from healthy donors could save thousands of lives. Second, it troubles me that we often expect the donors of kidneys and blood to act out of sheer altruism, but we have no such expectation of any of the other participants in an organ transplant, like the health care providers or the hospital. "

Tuesday, March 18, 2014

Lacetera, Macis and Stith on removing financial barriers to bone marrow donation

Removing financial barriers to organ and bone marrow donation: The effect of leave and tax legislation in the US
Lacetera, Nicola ; Macis, Mario; Stith, Sarah S.
Volume: 33, Jan 2014, 43-56

Many U.S. states have passed legislation providing leave to organ and bone marrow donors and/or tax benefits for live and deceased organ and bone marrow donations and to employers of donors. We exploit cross-state variation in the timing of such legislation to analyze its impact on organ donations by living and deceased persons, on measures of the quality of the transplants, and on the number of bone marrow donations. We find that these provisions do not have a significant impact on the quantity of organs donated. The leave laws, however, do have a positive impact on bone marrow donations, and the effect increases with the size of the population of beneficiaries and with the generosity of the legislative provisions. Our results suggest that this legislation works for moderately invasive procedures such as bone marrow donation, but these incentives may be too low for organ donation, which is riskier and more burdensome. 

Sunday, March 16, 2014

The IGM panel of economists speaks (in many voices) on paying for kidneys

The Initiative on Global Markets is an opinion poll of leading academic economists on a large variety of public policy questions, which they can answer on a range from "strongly agree" to "strongly disagree," along with "uncertain" or "no opinion". They are also asked to assess their confidence in their answer A recent question was
Supplying Kidneys: A market that allows payment for human kidneys should be established on a trial basis to help extend the lives of patients with kidney disease.

Here's a histogram of replies

Some answers were accompanied by comments, and I include all of those below...

AutorDavid AutorMITNo Opinion
Not enough info to answer. Not in favor of a kidney market that sells to highest bidder. Other ideas maybe. Question is not actionable. 
Bio/Vote History
BanerjeeAbhijit BanerjeeMITDisagree8
That would mean valuing people's lives by their incomes. We already do that but moving further in that direction seems wrong. 
Bio/Vote H
BrunnermeierMarkus BrunnermeierPrincetonAgree6
It is important that the market is "well regulated" in order to avoid abuse and exploitation of the vulnerables. 
ChevalierJudith ChevalierYaleStrongly Agree9
This certainly may have unintended consequences but it is hard to fault attempting to create more supply.
DuffieDarrell DuffieStanfordAgree3
Under strong governance that mitigates exploitation, this market may save lives on mutually consenting terms.
Bio/Vote History
EdlinAaron EdlinBerkeleyUncertain7
Dangerous ground, but a well-regulated experiment could be beneficial. Payments to fill out donor cards might increase supply, for example 
Bio/Vote History
EichengreenBarry EichengreenBerkeleyUncertain1
A market with or without subsidies for low income patients?
HallRobert HallStanfordUncertain9
Hard to know because we don't have much of an understanding of why people make organ gifts.
Bio/Vote History
HartOliver HartHarvardAgree8
I'd like to see it but I'm not sure the public is ready. Also would insurance cover this? Would people be able to top up (presumably)?
HoxbyCaroline HoxbyStanfordUncertain8
Would improve allocative efficiency but means- and health-conditioned vouchers would presumably have to be used to address ethical concerns.
JuddKenneth JuddStanfordStrongly Agree10
There is no reason to block this voluntary exchange. There may be unique challenges in applying laws against fraud, but nothing too hard.
NordhausWilliam NordhausYaleAgree5
Perhaps experiments in different regimes better idea.
SamuelsonLarry SamuelsonYaleDisagree6
We need to rationalize our organ allocation mechanism, but a market is not the only way, and is not obviously the best way. 
SchmalenseeRichard SchmalenseeMITUncertain7
How to deal with donors who don't understand risks, increased incentives to steal & import, perceived inequities...? Not simple.
ShapiroCarl ShapiroBerkeleyAgree8
Experiments seem valuable here, using health outcomes as our metric. Matching donors and recipients based in part on payment may be helpful.
Bio/Vote History
ShimerRobert ShimerChicagoStrongly Agree7
The biggest impact would be to increase kidney supply, so few obvious losers from this policy
Bio/Vote History
StokeyNancy StokeyChicagoUncertain1
It would surely save lives of those with kidney disease. It would probably have unintended consequences as well.
Bio/Vote History
ThalerRichard ThalerChicagoUncertain5
How should we incorporate the fact that nearly all non-economists hate this idea? Do we declare them wrong and proceed?
Bio/Vote History
UdryChristopher UdryYaleStrongly Agree1
As an economist, I strongly agree that there would be tremendous gains. But I'm uncertain of the appropriate bounds on market transactions.
-see background information here
-see background information here

Friday, March 14, 2014

Legal brothels in Germany

The Telegraph has the story: Welcome to Paradise (Paradise is the name of a brothel in Stuttgart.). It's an unusually good article, so here is an unusually long set of excerpts.  One of the reasons I follow this kind of debate is because of the similar, ongoing debate about whether the sale of kidneys should be legal.

"When Germany legalised prostitution in 2002 it triggered an apparently unstoppable growth in the country’s sex industry. It’s now worth 15 billion euros a year and embraces everything from 12-storey mega-brothels to outdoor sex boxes. Nisha Lilia Diu visits some of them to find out who won and who lost...
"Paradise is a chain, like Primark or Pizza Hut, with five branches and three more on the way.
"People think Amsterdam is the prostitution capital of Europe but Germany has more prostitutes per capita than any other country in the continent, more even than Thailand: 400,000 at the last count, serving 1.2 million men every day. Those figures were released a decade ago, soon after Germany made buying sex, selling sex, pimping and brothel-keeping legal in 2002. Two years later, prostitution in Germany was thought to be worth 6 billion euros – roughly the same as Porsche or Adidas that year. It’s now estimated to be 15 billion euros.
"The idea of the law, passed by Chancellor Gerhard Schröder’s Social Democrat-Green coalition, was to recognise prostitution as a job like any other. Sex workers could now enter into employment contracts, sue for payment and register for health insurance, pension plans and other benefits. Exploiting prostitutes was still criminal but everything else was now above board. Two female politicians and a Berlin madam were pictured clinking their champagne glasses in celebration.

"It didn’t work. “Nobody employs prostitutes in Germany,” says Beretin. None of the authorities I spoke to had ever heard of a prostitute suing for payment, either. And only 44 prostitutes have registered for benefits.

"What did happen was the opening of Europe’s biggest brothel – the 12-storey, neon-wrapped Pascha in Cologne. Not to mention a rash of FKK, or “naked”, clubs where men can spend the evening drifting between the sauna, the bar and the bedrooms. Bargain-hunters might try the “flat rate” brothels, where an entry fee of between 50-100 euros buys you unlimited sex with as many women as you want, or cruise the caravans at motorway truck stops, or the drive-through “sex boxes” in the street-walking zones. (They look like stables and are known as “verrichtungsboxen” - “getting things done boxes”.)

"The Netherlands legalised prostitution two years before Germany, just after Sweden had gone the other way and made the purchase of sex a criminal offence. Norway adopted the Swedish model - in which selling sex is permitted but anyone caught buying it is fined or imprisoned - in 2009. Iceland has followed suit, and France and Ireland look set to do the same.

"The Home Office insists Britain’s byzantine prostitution laws (in brief: you can buy and sell sex indoors under certain circumstances) are not up for review. But that might not be the case for long.

"Mary Honeyball, the Labour MEP, has been leading the charge to have the Swedish model adopted across Europe. Her bill was voted through by the European Parliament on 26 February, formally establishing the EU’s position on the issue. A few days later, on Monday, a cross-party report in Britain also recommended the model.

"Pressure to review prostitution laws is coming from an EU anti-trafficking directive that obliges member states to “reduce demand” for human trafficking. Given that at least 70 per cent of trafficking in Europe is into forced prostitution, a lot of people are arguing that the best way to reduce demand for trafficking is to reduce demand for prostitution. And one way to do that is to criminalise the buyer.
"More than 55,000 men come to Paradise every year. Everyone – punter and prostitute – pays a 79 euro entry fee. That includes food (there is a buffet right by the Jacuzzi into which a naked middle-aged man is lowering himself) but the sex is extra. That’s negotiated between the men and the women and all of the money from that activity is kept by her. The going rate at Paradise is about 50 euros for half an hour, slightly cheaper than the hammam – another extra – which is offered at 53 euros for 30 minutes.
"The law leaves [Saarbrücken’s mayor, Charlotte] Britz with her hands tied. “It’s easier to open a brothel in Germany than a chip shop,” she says. That’s actually true: while premises serving food need special licences there are no restrictions on brothels. That’s because all they do, technically, is rent rooms. The prostitutes are their customers just as much as the punters are. Sometimes, more so.
"Most [prostitutes] are in a similar situation to Suzi: her family has no idea what she’s doing and she has no desire to have an official record of her years in prostitution. “This work is not for a long time,” she says. “Very soon I will stop.” Once she’s saved up enough money, she plans to get a job in a hotel or a restaurant. Kristina Marlen, a tantric dominatrix in Berlin and a spokeswoman for Germany’s Trade Association for Erotic and Sexual Services, agrees. “A lot of people just do it for a short period in their lives. They don’t want to have in their CV, ‘I was a whore from 2007 to 2009’.”
"“People don’t employ prostitutes in Germany because it’s complicated,” says Beretin...
"Actually, says Knop, managing prostitutes is completely legal. The problem is making sure you don’t cross the line between “managing” them and “exploiting” them.
"Forced prostitution comes in many guises. Some women are kidnapped, others are tricked with the promise of jobs as nannies or waitresses. Others choose to work as prostitutes but have no idea of the conditions that await them. Often, a woman’s pimps or traffickers are people from her own town. They know where her family lives and aren’t afraid of harming them in order to control her. Sometimes it’s the families who pressure girls into prostitution in the first place - unable, or unwilling, to think of another way for a woman to earn a living.
"All the sex workers I spoke to, in Britain and in Germany, told me it’s “not for everyone.” Kristina Marlen, the Berlin dominatrix, sees her work in terms of “celebrating the sexual part of the person” (though “sometimes people come in and I am like ‘Ew’. But I can work with them.”) She’s bisexual and currently in an open relationship with a woman. She thinks of prostitution as its own kind of “sexual orientation”.

"But, she says, “there are some people working in the sex industry who shouldn’t be there.” Sex workers can find themselves in “very precarious positions and not all the women can articulate themselves as I can.” Even she has had “moments in which it wasn’t clear to me how to communicate boundaries.” You need to be thick-skinned and good at negotiating with strong boundaries and high self-esteem. There isn’t much of what’s been called “willing supply”.

Tuesday, February 25, 2014

Pros and cons of paying for kidneys, in the Journal of Medical Ethics

Some pros and cons on paying for kidneys in the Journal of Medical Ethics, March 2014, Volume 40, Issue 3

From the editors' summary in the first article ("The concise argument")"

"For over half a century the subject of organ transplantation has attracted ethical debate. One such ongoing debate, provoked by the severe scarcity of organs for transplantation and a concern to increase their supply, has been about why willing live donors should continue to be prohibited from offering their own organs for sale. Against allowing this, it has often been argued that prohibition protects people in poverty from being driven to, and then harmed by, this desperate last resort. But is that how such people in poverty themselves see it? From their point of view, it has been suggested, wouldn't it be reasonable to see prohibition as depriving them of their best option, leaving them worse off than if they had been able to exercise it? Isn't the claim to protect people in poverty therefore ‘misplaced paternalism’, providing no ethical justification for prohibition?

"In this month's feature article, Simon Rippon (see page 145, Editor's choice) mounts a serious and sustained challenge to that conclusion. He argues that while it would be reasonable for people in poverty to sell their organs if given the option, it would be equally reasonable, given the ‘significant and unavoidable’ harms of a live organ donor market, for them to prefer not to have this option at all. In her commentary on Rippon's paper, Janet Radcliffe-Richards (see page 152) acknowledges that ‘a plausible case for prohibition would probably take this form’, but goes on to argue that ‘although in principle prohibition need not be paternalistic, in practice it is’, since it ‘has been imposed on everyone irrespective of any consultation’. To this, and two further commentaries, by Gerald Dworkin (see page 151) and by Adrian Walsh (see page 153), Rippon responds (see page 155) in a significant contribution to a debate that nevertheless seems likely to continue unabated as long as the need for whole organs continues so greatly to exceed their supply."

The concise argument

Feature article

  • Editor's ChoiceFREE


Clinical ethics