Medical aid in dying to become available in New York State

 Here's the announcements from the New York State Governor's office:

Governor Hochul Reaches Agreement With State Legislature to Pass Medical Aid in Dying Act in New York  

"Governor Hochul today announced an agreement with the Legislature to make medical aid in dying available to terminally ill New Yorkers with less than six months to live. This comes after careful reflection and deliberation with the bill’s sponsors, advocacy organizations, and most importantly, everyday New Yorkers who shared personal experiences with the Governor. The bill, with the agreed-upon amendments, will be passed and signed in January, and the law will go into effect six months later.

“New York has long been a beacon of freedom, and now it is time we extend that freedom to terminally ill New Yorkers who want the right to die comfortably and on their own terms,” said Governor Hochul. “My mother died of ALS, and I am all too familiar with the pain of seeing someone you love suffer and being powerless to stop it. Although this was an incredibly difficult decision, I ultimately determined that with the additional guardrails agreed upon with the legislature, this bill would allow New Yorkers to suffer less–to shorten not their lives, but their deaths.”
 

"The bill, as passed by the Legislature, had a number of protections in place to ensure that no patient was coerced into utilizing medical aid in dying and no doctor or religiously affiliated health facility was forced to offer medical aid in dying. With today’s agreement, the Governor announces a number of additional guardrails that the Legislature has agreed to enact aimed at ensuring the integrity of the patient’s decision and the preparedness of medical institutions to appropriately administer medical aid in dying. Today’s agreement memorializes a shared path forward on this bill, with additional key guardrails, including:

    A mandatory waiting period of 5 days between when a prescription is written and filled.
    An oral request by the patient for medical aid in dying must be recorded by video or audio.
    A mandatory mental health evaluation of the patient seeking medical aid in dying by a psychologist or psychiatrist.
    A prohibition against anyone who may benefit financially from the death of a patient from being eligible to serve as a witness to the oral request or an interpreter for the patient.
    Limiting the availability of medical aid in dying to New York residents.
    Requiring that the initial evaluation of a patient by a physician be in person.
    Allowing religiously-oriented home hospice providers to opt out of offering medical aid in dying.
    Ensuring that a violation of the law is defined as professional misconduct under the Education Law.
    Extending the effective date of the bill to six months after signing to allow the Department of Health to put into place regulations required to implement the law while also ensuring that health care facilities can properly prepare and train staff for compliance."

 

The market for used underwear, in the journal Genre, sexualité & société

 The study of repugnant transactions and controversial markets can lead to some strange markets.

 In the latest issue of the journal Genre, sexualité & société (after right clicking to translate to English) :

Product qualification in a contested market: The case of the used underwear market
by Ludine Cayla and Julien Gradoz
https://doi-org.stanford.idm.oclc.org/10.4000/154ww 

Abstract: This article focuses on the used underwear market, defined as the market for underwear that has been worn by one or more individuals and sold unwashed, meaning it contains deliberately left secretions and fluids. It distinguishes websites where the nature of the product sold must be concealed (such as resale websites for secondhand items) due to the prohibition of the transactions, and websites where the product can be openly discussed (such as websites specializing in the sale of sexual items). This distinction allows for the study of the issue of product qualification and disqualification in a contested market, which has been hardly explored. More broadly, this article helps identify the main characteristics of an overlooked market that, until now, has only been the subject of sensationalist analyses. 

"this is a "contested market," that is, a market in which some people would like to carry out transactions, but third parties oppose them on the basis of moral considerations. This opposition can then translate into constraints placed on the organization of the market (Roth, 2007), such as its prohibition (e.g., organs), the prohibition of advertising (cigarettes), difficulties in obtaining a bank loan (pornography), the imposition of punitive taxes (sodas), or even the stigmatization of participants in the transactions. Contested markets have been the subject of a substantial body of literature over the past decade (e.g., Steiner and Trespeuch, 2014; Bertrand et al ., 2020; Bertrand and Panitch, 2024; Gradoz and Dekker, 2025), and this article proposes to analyze the used underwear market based on this literature, moving beyond the sensationalism that has prevailed until now. This literature has focused in particular on the justifications used by third parties to challenge the existence of certain markets, or on the strategies implemented by participants in transactions to cope with the constraints resulting from this challenge." 

The national politics of deceased organ donation

 The U.S. transplant system is relatively open to foreign patients, and the NYT reports with some concern the number of foreign citizens receiving scarce organs from deceased donors, sometimes paying full list price to the hospitals involved.  One question I have that I haven't seen addressed in discussions of this type is how many foreign citizens who happen to die while visiting the US become deceased organ donors?

Here's the NYT:

Hospitals Cater to ‘Transplant Tourists’ as U.S. Patients Wait for Organs
International patients can bring a hospital as much as $2 million for a transplant. In recent years, they have typically gotten organs faster than U.S. patients. By Brian M. Rosenthal and Mark Hansen

  "In the past dozen years, more than 1,400 patients from abroad received a transplant in the United States after traveling specifically for the procedure. That was a small fraction of all U.S. transplants, and most transplant centers did not operate on international patients at all.

"But The Times found that a handful of hospitals are increasingly catering to overseas patients, who make up an ever-larger share of their organ recipients: 11 percent for hearts and lungs at the University of Chicago; 20 percent for lungs at Montefiore Medical Center in the Bronx; 16 percent for lungs at UC San Diego Health; 10 percent for intestines at MedStar Georgetown University Hospital in Washington; and 8 percent for livers at Memorial Hermann-Texas Medical Center in Houston.

"In many countries, this would be illegal. World leaders agreed in 2008 to fight so-called transplant tourism, and most nations do not provide organs to overseas patients. Yet the United States has long allowed it. The policy has drawn criticism in the past, such as when organs went to Saudi royals and a Japanese crime boss. 

...

"Dr. Mark Fox, a former chair of the transplant system’s ethics committee, said the findings were troubling, especially because overseas patients do not contribute to America’s pool of donated organs. “The unfortunate reality is that we don’t have enough organs,” he said. “When people jet in, get an organ and jet home, it’s a problem. It’s not fair.” 

 ##########

I'm reminded of this 2018 article which expressed a similar concern :

Delmonico, F. L., Gunderson, S., Iyer, K. R., Danovitch, G. M., Pruett, T. L., Reyes, J. D., & Ascher, N. L. (2018). Deceased donor organ transplantation performed in the United States for noncitizens and nonresidents. Transplantation, 102(7), 1124-1131. 

Abstract: "Since 2012, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) has required transplant centers to record the citizenship residency status of patients undergoing transplantation in the United States. This policy replaced the 5% threshold of the non–US citizen/nonresidents (NC/NR) undergoing organ transplantation that could result in an audit of transplant center activity. Since April 1, 2015, the country of residence for the NC/NR on the waitlist has also been recorded. We analyzed the frequency of NC/NR deceased donor organ transplants and waitlist registrations at all US transplant centers by data provided by UNOS for that purpose to the UNOS Ad Hoc International Relations Committee. During the period of 2013 to 2016, 1176 deceased donor transplants (of all organs) were performed in non–US citizen/non–US resident (NC/NR) candidates (0.54% of the total number of transplants). We focused on high-volume NC/NR transplant centers that performed more than 5% of the deceased donor kidney or liver transplants in NC/NR or whose waitlist registrants exceeded 5% NC/NR. This report was prepared to fulfill the transparency policy of UNOS to assure a public trust in the distribution of organs. When viewed with a public awareness of deceased donor organ shortages, it suggests the need for a more comprehensive understanding of current NC/NR activity in the United States. Patterns of organ specific NC/NR registrations and transplantations at high-volume centers should prompt a review of transplant center practices to determine whether the deceased donor and center resources may be compromised for their US patients." 

They note that " a noncitizen/nonresident could be a foreign student or businessperson traveling to the United States, whereas an undocumented individual living in the United States would also be a noncitizen/resident." 

The local politics of deceased organ donation

 "All politics is local" may not be entirely true, but local politics doesn't end at death.

MedPage Today has the story: 

Senators Urge More Localized Use of Donor Organs
— "Too many of our organs are leaving" the geographic area, says Sen. Roger Marshall, MD
by Joyce Frieden, 

"More needs to be done to make sure donated organs are transplanted to recipients within the local geographic area whenever possible, several senators said Thursday at a hearing on the future of the organ procurement and transplantation network.

"The Midwest, where I'm from ... is famous that we have a higher organ donor rate than the [East or West] coasts do typically," said Sen. Roger Marshall, MD (R-Kansas). "And you know, there's a concern that too many of our organs are leaving the Midwest." 

Australia's ban on social media use by teens under sixteen

 Australia has put into effect a ban on social media use by teenagers younger than 16.  My first thought is, good luck with that...

Here are some headlines that caught my eye:

From MSN: 

Australian leader defends social media ban as teens flaunt workarounds  by Byron Kaye 

"A day after the law took effect with bipartisan support from the major political parties and backing by some three-quarters of Australian parents, the country's social media feeds were flooded with comments from people claiming to be under 16, including one on the prime minister's TikTok account saying "I'm still here, wait until I can vote".

####### 

And (more optimistically) from Nature:

Australia’s world-first social media ban is a ‘natural experiment’ for scientists
Researchers will study the effects of the policy on young people’s mental health, social interactions and political engagement.   By Rachel Fieldhouse & Mohana Basu 

" Many teenagers in the country are furious, but for social scientists, the policy offers a natural experiment to study the effects of social-media restrictions on young people." 

########

And this:

Social Media Lab Appointed as Lead Academic Partner for Australian Legislation 

Yuck! and the long journey to a book title

 

As I mentioned in yesterday's post, I'm working on the galleys of my forthcoming book, Moral Economics. This has reminded me of the long journey to a book title.

 

For one thing, the British title isn't exactly  the same as the American title--they have different subtitles. British readers will have to open the book to discover that prostitution and organ sales are among the topics covered, while American readers can see this on the cover.

 

  

My original, working title was "Controversial Markets and Repugnant  Transactions," based in part on my 2007 article  "Repugnance as a Constraint on Markets".  But I soon realized that when non-economists heard me mention that a transaction was repugnant, they thought I meant that I didn't like it and that they shouldn't either, when what I did mean was merely that some people object to it, often on moral grounds.

So for a while my working title became "Controversial Markets and Morally Contested Transactions." 

That's descriptive, but clunky.  So I didn't resist too much when my publisher suggested "Moral Economics," although I worried that was too cryptic, so a sub-title would be needed.

And all of this is stored in a folder with the title "Yuck" that I opened on my hard drive when I first started to think about writing a book on repugnant transactions. 

New book! Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work--forthcoming!

 

 I have a forthcoming book, (at long last) and it now even has a cover. (Note the halo:)  I'm reading the galleys right now...

 

Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work    forthcoming – May 12, 2026

also available to preorder at other fine bookstores. (I'll be happy to autograph pre-orders that are mailed to me, btw...)

 

"A Nobel Prize–⁠winning economist shows us why we have to deal in trade-offs when we can’t agree on what’s right and what’s wrong

"Some of the most intractable controversies in our divided society are, at bottom, about what actions and transactions should be banned. Should women and couples be able to purchase contraception, access in vitro fertilization, and end pregnancy by obtaining an abortion? Should people be able to buy marijuana? What about fentanyl? Can someone be paid to donate blood plasma, or a kidney?

"Disagreements are fierce because arguments on both sides are often made in uncompromising moral or religious terms. But in Moral Economics, Nobel Prize–winning economist Alvin E. Roth asserts that we can make progress on these and other difficult topics if we view them as markets—tools to help decide who gets what—and understand how those markets can be fine-tuned to be more functional. Markets don’t have to allow everything or ban everything. Prudent market design can find a balance between preserving people’s rights to pursue their own interests and protecting the most vulnerable from harm.

"Combining Roth’s unparalleled expertise as market design pioneer with his incisive, witty accounts of complicated issues, Moral Economics offers a powerful and innovative new framework for resolving today’s hardest controversies. "

 

Notes from Messina (kidney exchange and the Accademia Peloritana dei Pericolanti)

 We traveled last week from Prague to Sicily, for the Matching in Practice workshop in  Messina, which was rich in kidney exchange. I was glad to reconnect with the Director of the National Transplant organization, Dr. Giuseppe Feltrin, and with Professors Antonio Nicolò and Antonio Miralles.

But a funny thing happened first, at the University of Messina. I was inducted into the university's Accademia Peloritana dei Pericolanti, founded in the early 1700's, at a time when autocrats didn't look fondly on universities (imagine that!). The symbol of the Academy is a ship sailing in the Strait of Messina (between Scylla and Charybdis) with the motto "Inter utramque viam periclitantes," "Taking risks between both paths," reflecting (I was told) the perils of navigating the strait between scholarship and politics.  It seemed very appropriate for the times.

Here's the story in the local news: with a picture:

 

Notes from Prague (kidney exchange, market design, and progress on a new book)

I flew back to California yesterday, after spending some time in Czechia and Italy talking about kidney exchange.  Here is a video of the public talk I gave at Prague Castle.  Among other things it highlights the Czech kidney exchanges with Israel. (I had the pleasure of meeting  Prof. Jiri Fronek, the distinguished surgical pioneer who led the Czech side of that effort.)

https://youtu.be/jrrlNWMkQyE?feature=shared

I also had the privilege of visiting CERGE-EI  (Center for Economic Research and Graduate Education - Economics Institute) where my host was Prof  Štěpán Jurajda.  He and I first met when we were both at the University of Pittsburgh in the 1990s.

And here's an interview with the Economic newspaper  Hospodářské noviny  that starts off with the optimistic notion that I may have just (largely) completed the draft of a new book:)

Zkoumá trhy, kde peníze nevládnou. Ledvinu ani lásku si za ně většinou nekoupíte, říká nobelista Alvin Roth [ He explores markets where money doesn't rule. You can't usually buy a kidney or love with it, says Nobel laureate Alvin Roth]

“Before flying from the USA to Prague, economist and Nobel laureate Alvin Roth managed to send the publisher a draft of his new book, which he is currently finishing. He calls it Controversial Markets. Between an afternoon lecture for students at the CERGE-EI Institute in Prague and an evening lecture at Prague Castle, he also found time for an interview with Hospodářské noviny, in which he outlines what his new book will be about. One of the controversial markets he deals with, for example, is the organ transplant market."