Showing posts with label ethics. Show all posts
Showing posts with label ethics. Show all posts

Thursday, November 21, 2024

If I don't do it someone else will: markets and morals

 Here's a paper reporting an experiment that suggests that people are more willing to ignore the negative externalities they impose on others in a market in which they have little effect on quantities consumed. (They interpret this as being a moral question, hence the title.)

Ziegler, Andreas GB, Giorgia Romagnoli, and Theo Offerman. "Morals in multi-unit markets." Journal of the European Economic Association, Volume 22, Issue 5, October 2024, Pages 2225–2260, https://doi.org/10.1093/jeea/jvae001

"Abstract: We examine how the erosion of morals, norms, and norm compliance in markets depends on the market power of individual traders. Previously studied markets allow traders to exchange at most one unit and provide market power to individual traders by de-activating two forces: (i) the replacement logic, whereby immoral trading is justified by the belief that others would trade otherwise and (ii) market selection, by which the least moral trader determines aggregate quantities. In an experiment, we compare single-unit to (more common) multi-unit markets, which may activate these forces. Multi-unit markets, in contrast to single-unit markets, lead to a complete erosion of morals. This is associated primarily with a deterioration in norm compliance: the observed level of immoral trade is in contrast with the prevailing social norm. The replacement logic is the main mechanism driving this finding.


HT: Stephanie Wang


Sunday, November 10, 2024

Peter Singer interview in the NYT

 The NYT interviews the eminent philosopher:

Peter Singer Wants to Shatter Your Moral Complacency  By David Marchese

Q. "I think of you as being best known for your work on animals and ethics, which flows out of utilitarian principles — that the right action is the one that produces the most good. But you’re also seen as one of the godfathers of effective altruism. Can you explain what effective altruism is and how it builds on utilitarianism?

A. "Sure. Effective altruism is the view that firstly, we ought to try to make the world a better place. Doesn’t mean that we all have to become saints, but it should be an important goal for people to think, What can I do to make the world better? And to think about that in a global way, not just for me and my family and those close to me but for people anywhere in the world and, indeed, for beings capable of suffering who are not of our species. Effective altruism developed into a kind of a social movement to encourage people to do that, and effective altruists have done a lot of research to try to find which are the most effective charities in different areas. What is the connection with utilitarianism? I think if you are a utilitarian, you ought to be an effective altruist. Because if you’re a utilitarian you ought to want to reduce suffering and increase happiness, and given that we all have limited resources, surely we should be using those resources as effectively as possible to do as much good as we can."

######

Earlier: Singer is one of the founding editors of the Journal of controversial ideas (which has a large, diverse and distinguished editorial board):

Friday, May 21, 2021  Journal of controversial ideas


and he defends sensible views on kidney exchange:

Saturday, November 2, 2019

Video Interview: Peter Singer on Global Kidney Exchange

Peter Singer discusses Global Kidney Exchange, and his recent article in the Lancet, in this interview on the Practical Ethics blog at Oxford.

Saturday, July 6, 2024

Morals and the limits of markets, WZB Berlin, 11 - 12 July 2024

 Here's a conference that looks interesting:

Morals and the limits of markets, WZB Berlin, 11 - 12 July 2024

Organizers:  Hande Erkut and Dorothea Kübler

"The workshop will focus on the limits of markets, the morality of decisions in markets, and paternalism. It will bring together scholars from different disciplines (mainly economics, political science, and philosophy) who are working on these topics. The workshop aims to foster discussions across disciplines on the ethical considerations surrounding market activities, repugnant markets, and the government’s role in regulating such markets."

Preliminary Program:Preliminary Program:

Thursday, July 11, 2024

9:00 – 9.30 Registration/ Workshop Opening

9:30 – 10.50 Sandro Ambühl (University of Zurich)  Interventionist Preferences and the Welfare State: The Case of In-Kind Nutrition Assistance

Tammy Harel Ben Shahar (University of Haifa), Lean Out: On the Morality of Participating in Positional Competitions

10:50 – 11:10 Coffee Break

11:10 – 12:30 Benjamin Sachs-Cobbe (University of St Andrews) Taking Jobs and Doing Harm

Colin Sullivan (Purdue University) Paternalistic Discrimination

12.30 – 13:20 Lunch

13:20 – 15:20 Hande Erkut (WZB), Repugnant Transactions: The Role of Agency and Severe Consequences

Erik Malmqvist (Univeristy of Gothenburg)  How Exploitation Harms

Constanze Binder (Erasmus University Rotterdam) Universities and Markets: New Challenges to Academic Freedom

15:20 – 15:50 Coffee Break

15.50 – 17:10 Robert Stüber (NYU Abu Dhabi) Why High Incentives Cause Repugnance: A Framed Field Experiment + Do Prices Erode Values

Aksel Sterri (Oslo Metropolitan University)  Bodily Justice

17:30 Visit to Neue Nationalgalerie

19:00 Conference Dinner


Friday, July 12, 2024

9.30 – 10:50 Axel Ockenfels (University of Cologne)  The Demand and Supply of Paternalism

Søren Flinch Midtgaard (Aarhus University) Reaction Qualifications and Paternalism

10:50 – 11.10 Coffee Break

11:10 – 12:30 Roberto Weber (University of Zurich) What Money Shouldn’t Buy: Aversion to Monetary Incentives for Health Behaviors

Amy Thompson (Oxford University) Defending a Moral Limit to Markets: Beyond a Singular Asymmetry Thesis

12.30 – 13:30 Lunch

13:30 – 15:30 Sili Zhang (LMU Munich)  What Money Can Buy: How Market Exchange Promotes Values

Peter Dietsch (University of Victoria)  The Centrifugal Nature of the Labour Market, Justice, and Public  Policy

Rahel Jaeggi (Humboldt University Berlin)  TBA

15:30 – 16:40 Coffee Break / Poster Session

Miguel Abellán (University Lüneburg) Timo Heinrich (TU Hamburg)

Victor Chung (University of Toronto) Iliana Melero (University of Zaragoza)

Denise Feigl (University of Regensburg) Brandon Long (University at Buffalo)

Ben Grodeck (University of Exeter) Reha Tuncer (LISER)

16:40 – 18:00 Nicola Lacetera (University of Toronto) Save and Let Die? Economic Factors and the Support of Medically Assisted Death

Stefan Gosepath (Frei University Berlin) Containment of the Market

19:00 Farewell Dinner


Saturday, June 8, 2024

The ethics of field experiments in Economics, in the Financial Times

 The Financial Times has a column about the recent twitter (X) discussion concerning our paper Social Media and Job Market Success: A Field Experiment on Twitter, by Jingyi Qiu, Yan Chen, Alain Cohn, and Alvin E. Roth.

That twitter-up concerned whether it is ethical to do field experiments in economics, in which some argued that the benefits that might accrue to treated market participants may disadvantage untreated market participants, including those not involved in the experiment and from whom consent was not obtained. (The FT column has a paragraph in which Douglas MacKay*, a bio-ethicist from UNC considers ethical issues that might arise if the market "is a zero sum competition.") 

Here's the FT article, and the snippet that covers our paper.

When is it OK for economists to experiment on people? A recent study has raised ethical questions about research.  by Soumaya Keynes, Financial Times.

"While most economic debates are about as spicy as boiled potatoes, others generate a bit more heat. A recent stir fell into the second category, in response to a new study of junior academics angling for jobs in economics. 

...

"Alvin Roth, one of the authors of that experiment, says: “I can’t imagine economists thinking of a market as zero sum.” Perhaps a social media post could alert someone to a candidate so impressive that they persuade their university to make an extra position available. He points out that plenty of people share papers on social media, adding: “It seems to me that things that aren’t unethical to do shouldn’t be unethical to study to find out their effect.”

############

Here's my earlier post, of the paper, with some thoughts on the ethics of experimenting.

Thursday, May 23, 2024

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*And here is an interesting looking bibliography, including some papers by economists.
Prepared and Managed by Emma Cohn and Douglas MacKay

Thursday, May 23, 2024

Social Media and Job Market Success: A Field Experiment on Twitter, by Qiu, Chen, Cohn, and Roth

 Here's a new working paper on SSRN:

Social Media and Job Market Success: A Field Experiment on Twitter, by Jingyi Qiu, Yan Chen, Alain Cohn, and Alvin E. Roth, May 20, 2024

"Abstract: We conducted a field experiment on Twitter to examine the impact of social media promotion on job market outcomes in economics. Half of the 519 job market papers tweeted from our research account were randomly assigned to be quote-tweeted by prominent economists. Papers assigned to be quote-tweeted received 442% more views and 303% more likes. Moreover, candidates in the treatment group received one additional flyout, with women receiving 0.9 more job offers. These findings suggest that social media promotion can improve the visibility and success of job market candidates, especially for underrepresented groups in economics such as women."


I gather that our paper has gone somewhat viral on twitter, with discussion about whether field experiments on job markets are ethical.  That's not a bad discussion to have, and of course we discussed that in the course of planning this experiment. (A similar discussion can and should be be had about any intervention in a market, not just an experiment.*)

Here is what we had to say about that in the paper.

"Despite the positive outcomes, one might question the ethics of our intervention, which randomly promotes a subset of JMPs on social media. However, we observe that senior economists naturally promote their own students and coauthors on Twitter. In comparison, we tweeted every JMP in our sample from our dedicated research account. Furthermore, while 80% of the influencers in our sample come from top 30 institutions, they quote-tweeted JMPs from a broader spectrum of academic institutions, thus allocating attention more equitably. Given that 92% of the JMCs in both the treatment and control groups accepted a job, it is unlikely that our treatment displaced those in the control group. The current focus on diversity, equity, and inclusion suggests that highlighting suitable candidates could potentially expand the number of job openings, making the job market for economists not entirely zero-sum. Lastly, the differential benefit of our treatment for women contributes to fostering a more inclusive economics profession. In summary, we argue that the knowledge gained from our experiment outweighs the potential cost."


*I've been involved in several operational (i.e. not experimental) interventions in job markets, including  the job market for new Econ Ph.D.s (e.g. signaling and the scramble):  see 

 Coles, Peter, John H. Cawley, Phillip B. Levine, Muriel Niederle, Alvin E. Roth, and John J. Siegfried, “The Job Market for New Economists: A Market Design Perspective,” Journal of Economic Perspectives, 24,4, Fall 2010, 187-206.  https://www.aeaweb.org/articles?id=10.1257/jep.24.4.187


Wednesday, April 24, 2024

The Ethical Limits of Markets by Kim Krawiec

 Here's a new summary by one of the leading scholars of "taboo trades."

Kimberly D. Krawiec, "The Ethical Limits of Markets: Market Inalienability," Forthcoming, The Research Handbook On The Philosophy of Contract Law (edited by Mindy Chen-Wishart and Prince Saprai)   3 Apr 2024

Abstract: Although ethical critiques of markets are longstanding, modern academic debates about the “moral limits of markets” (MLM) tend to be fairly limited in scope. These disputes center, not on the dangers of markets per se, but on the dangers of exchanging particular items and activities through the marketplace. Proponents of MLM theories thus do not want to eliminate markets entirely, but instead seek to identify the moral and ethical boundaries of the marketplace by considering which goods and services are inappropriate for market trading. This chapter summarizes and categorizes some of the more important arguments within this debate, with a focus on recent research, controversies, and applications. The goal is to provide an overview of these debates, highlighting some of the topics that have generated robust discussion, particularly when relatively recent empirical or theoretical work may shed new light on a topic. Specifically, I focus on crowding out, corruption, leaving a space for altruism, equality, and a trio of related debates regarding paternalism (coercion, unjust inducement, and exploitation).

Here's her opening paragraph:

"Markets have limits—even the staunchest libertarian agrees with that idea.1 But the consensus ends there. There is no agreement on what those limits should be or why, as demonstrated by the vast variation in legal regimes around the world. For example, markets in sex are legal in much of the world and illegal in most of the United States.2 Markets in gametes and surrogacy services are legal and thriving in most of the United States and illegal in much of the rest of the world.3 Most of the world prohibits payments to plasma donors and, as a result, are forced to meet their domestic plasma needs by importing plasma-derived products from the United States, which in turn meets demand by paying plasma donors.

Monday, January 29, 2024

"There are tradeoffs everywhere" Alfred Spector on artificial intelligence.

 Alfred Spector has written an article called : Gaining Benefit from AI and Data Science: A Three-Part Framework. Among other things, he argues that neither technologists alone, nor ethicists alone, will find themselves automatically well equipped to think about the tradeoffs involved in developing, deploying, and regulating artificial intelligence.  

Here's a short (5 min) video produced by the ACM in which he calls for a broad approach.

Gaining Benefit from Artificial Intelligence and Data Science: A Three-Part Framework from CACM on Vimeo.

Sunday, October 22, 2023

Markets, Virtues and Ethics

 Do markets complement virtues, or sideline them?  Here's another entry into that discussion.

Reese, A., Pies, I. Solidarity Among Strangers During Natural Disasters: How Economic Insights May Improve Our Understanding of Virtues. J Ethics (2023). https://doi.org/10.1007/s10892-023-09460-7

"Abstract: The renaissance of Aristotelian virtue ethics has produced an extensive philosophical literature that criticizes markets for a lack of virtues. Drawing on Michael Sandel’s virtue-ethical critique of price gouging during natural disasters, we (1) identify and clarify serious misunderstandings in recurring price-gouging debates between virtue-ethical critics and economists. Subsequently, (2) we respond to Sandel’s call for interdisciplinary dialogue. However, instead of solely calling on economics to embrace insights from virtue ethics, we prefer a two-sided version of interdisciplinary dialogue and argue that virtue ethics should embrace economic insights. In particular, we argue that if virtue ethics is to preserve its social relevance under modern conditions, it should re-conceptualize its notion of virtue and re-evaluate the self-interested but effective—and in this sense solidary—help among strangers via markets as virtuous rather than devaluate it as greed, that is, as vicious price gouging.

...

"Most forms of virtue ethics share a central concern for the moral character of a person, the development of excellence, and an emphasis on avoiding vices and pursuing virtues. This means that in essence, the virtue ethics perspective focuses on good intentions and intended consequences. In contrast, modern economics fosters a systems approach to situational incentives and thus shifts the perspective to focus on the unintended consequences of intentional actions.

...

" Roth (2007) acknowledges repugnance and other kinds of assumed moral inappropriateness as real constraints on market design. He takes moral feelings seriously and proposes market arrangements that do not evoke such feelings. For example, many people experience a feeling of unease with the idea of being able to buy and sell kidneys, which is currently possible for Iranians in the Islamic Republic of Iran. By designing in-kind kidney exchanges, Roth has shown ways to facilitate market transactions that operate entirely without money and, as such, do not evoke repugnant reactions (Leider and Roth 2010; Roth 2016). Surely, there are still too many people desperately waiting for a kidney. However, the implementation of in-kind exchanges has saved lives. It has helped a significant number of people obtain a kidney that would have obtained none without such a system. In line with Roth, we take the virtue argument seriously. However, we choose a longer time horizon where the assumed moral inappropriateness is no longer a given constraint on market design but becomes, at least in principle, a variable.

...

"Sandel insists on deciding case by case whether we should give the virtue of (probably less effective) selfless help precedence over the assumed repugnance of (probably more effective) self-interested help via markets, or vice versa.

...

"Reassessments of social practices are not uncommon throughout history. Most people today perceive the practices of charging interest rates, dueling, and paying opera singers for their performance differently than their ancestors. 

Sunday, May 14, 2023

Morality in Economics, as viewed from Sociology (Georg Kanitsar in European J. of Sociology)

Georg Kanitsar, a young sociologist, undertakes the task of looking at how economists think about morality (with a focus on experimental and behavioral econ, and market design). His view of how economists think may shed some light (for economists) on how sociologists think. (I quote below from near the beginning and near the end of his paper.)

Kanitsar, G. (2023). Putting Morals into Economics: From Value Neutrality to the Moral Economy and the Economization of Morality. European Journal of Sociology / Archives Européennes De Sociologie, 1-30. doi:10.1017/

"Abstract: The economic discipline plays a performative role in constructing the moral order of market society. Yet, little attention has been paid to what economists explicitly regard as moral or how they conceive of morality. This article reflects a recent attempt to put morals into economics, that is, to introduce morality as a research topic in behavioural and experimental economics. It maps three research programs that theorize the moral economy. The programs emphasize the moral foundations of market society, the moral limits of market expansion, and the moral consequences of market trading and, thus, appear irreconcilable with classifications of economists as market enthusiasts or moral agnostics. At the same time, however, the literature centres on an “economized” form of morality that is corrective to market inefficiencies, attributed to the responsibility of the individual, and expressed in rational terms. In doing so, this literature contributes to redefining moral problems in economic terms."

"I consider efforts to incorporate morality into an economic framework advanced by two influential branches of the discipline—behavioural economics and market experiments. To gain an overview of relevant research in these branches, I assemble a database of 39 recent articles and identify 20 key articles among them.

...

I explore the “economization of morality” by elucidating the moral arguments and the moral background of two authoritative programs in present-day economics: behavioural economics/experiments and market design/experiments. While many renowned economists have produced notable work on morality, these two research programs currently exert a unique influence on the economic discipline and are highly industrious in exporting its findings to policy making.

...

"Discourse in the economic mainstream was long dominated by market enthusiasts and moral agnostics, but the recent surge of behavioural and market experiments has again drawn attention to morality as a research topic in economics. At the argumentative level, the reviewed literature reveals a genuine break with market fundamentalism in the narrow sense. I have identified three strands that shed light on the moral economy and emphasize the moral foundations, limitations, and consequences of markets. Thus, economics has not been deaf to appeals to “put morals into markets” [Amable Reference Amable2011]. At the background level, however, the integration of morality is steered by the discipline’s theoretical and methodological underpinnings. In consequence, a very specific understanding of morality lies at the heart of these research efforts; a form of morality that is functional to market efficiency and attributed to utility-maximizing individuals.

...

"Behavioural economics thus strikes out in the opposite direction as scholarship in economic sociology. On the surface, both disciplines take as a starting point a view of market society as divided in arm’s-length transactions and social ties, and both disciplines have rediscovered morality as their subject matter. Yet, behavioural economics addresses the social sphere with tools that were tailor-made for the neoclassical analysis of markets. The field maintains the analytical primacy on efficiency and rationality, which it inherited from its parent discipline. In experiments, social exchanges are represented as contractual, anonymous, and temporary encounters, and money is regarded as a neutral tool used to express valuations. Conversely, economic sociology views markets as diverse “arenas of social interaction” [Beckert Reference Beckert2009: 245]. Market transactions are considered as far from universal, arelational, and disembedded [Aspers Reference Aspers, Beckert and Zafirovski2005], and the cultural meanings of money rarely reduce it to a qualityless, neutral, and homogenous medium of exchange [Zelizer Reference Zelizer1989]. Thus, the “moral economy” of behavioural economics is situated next to the “amoral economy” of neoclassical economics [Bowles Reference Bowles2016], echoing the traditional opposition between separate spheres of the economic and the moral [Thompson Reference Thompson E1971]. By contrast, economic sociology is increasingly devoted to identifying the multiple moralities underlying economic processes [Beckert Reference Beckert2012; Zelizer Rotman Reference Zelizer Rotman2017], convinced that “all economies are moral economies” [Fourcade Reference Fourcade2017: 665]."

Sunday, January 8, 2023

Moral certainties versus moral tradeoffs

 An article and a commentary in PNAS raise the possibility that  economists and psychologists and moral philosophers concerned with morally contested transactions may be able to engage in more useful discussions. A problem is that economists mostly think about tradeoffs while many moral philosophers (or at least those who write about medical ethics) often think of morality as involving absolutes. (This is clearly illustrated in discussions about repugnant transactions, such as those involving compensation of donors of blood plasma or kidneys, for example.)

The PNAS article is   

Guzmán, Ricardo Andrés, María Teresa Barbato, Daniel Sznycer, and Leda Cosmides. "A moral trade-off system produces intuitive judgments that are rational and coherent and strike a balance between conflicting moral values." Proceedings of the National Academy of Sciences 119, no. 42 (2022): e2214005119. https://doi.org/10.1073/pnas.2214005119

"Significance: Intuitions about right and wrong clash in moral dilemmas. We report evidence that dilemmas activate a moral trade-off system: a cognitive system that is well designed for making trade-offs between conflicting moral values. When asked which option for resolving a dilemma is morally right, many people made compromise judgments, which strike a balance between conflicting moral values by partially satisfying both. Furthermore, their moral judgments satisfied a demanding standard of rational choice: the Generalized Axiom of Revealed Preferences. Deliberative reasoning cannot explain these results, nor can a tug-of-war between emotion and reason. The results are the signature of a cognitive system that weighs competing moral considerations and chooses the solution that maximizes rightness.

"Abstract: How does the mind make moral judgments when the only way to satisfy one moral value is to neglect another? Moral dilemmas posed a recurrent adaptive problem for ancestral hominins, whose cooperative social life created multiple responsibilities to others. For many dilemmas, striking a balance between two conflicting values (a compromise judgment) would have promoted fitness better than neglecting one value to fully satisfy the other (an extreme judgment). We propose that natural selection favored the evolution of a cognitive system designed for making trade-offs between conflicting moral values. Its nonconscious computations respond to dilemmas by constructing “rightness functions”: temporary representations specific to the situation at hand. A rightness function represents, in compact form, an ordering of all the solutions that the mind can conceive of (whether feasible or not) in terms of moral rightness. An optimizing algorithm selects, among the feasible solutions, one with the highest level of rightness. The moral trade-off system hypothesis makes various novel predictions: People make compromise judgments, judgments respond to incentives, judgments respect the axioms of rational choice, and judgments respond coherently to morally relevant variables (such as willingness, fairness, and reciprocity). We successfully tested these predictions using a new trolley-like dilemma. This dilemma has two original features: It admits both extreme and compromise judgments, and it allows incentives—in this case, the human cost of saving lives—to be varied systematically. No other existing model predicts the experimental results, which contradict an influential dual-process model."

Here is their first example:

"Two countries, A and B, have been at war for years (you are not a citizen of either country). The war was initiated by the rulers of B, against the will of the civilian population. Recently, the military equilibrium has broken, and it is certain that A will win. The question is how, when, and at what cost.

"Country A has two strategies available: attacking the opposing army with conventional weapons and bombing the civilian population. They could use one, the other, or a combination of both. Bombing would demoralize country B: The more civilians are killed, the sooner B will surrender, and the fewer soldiers will die—about half from both sides, all forcibly drafted. Conventional fighting will minimize civilian casualties but maximize lives lost (all soldiers).

"More precisely: If country A chooses not to bomb country B, then 6 million soldiers will die, but almost no civilians. If 4 million civilians are sacrificed in the bombings, B will surrender immediately, and almost no soldiers will die. And, if A chooses an intermediate solution, for every four civilians sacrificed, approximately six fewer soldiers will die.

"How should country A end the war? What do you feel is morally right?"

**********

Here is the followup commentary:

Lieberman, Debra, and Steven Shenouda. "The superior explanatory power of models that admit trade-offs in moral judgment and decision-making." Proceedings of the National Academy of Sciences 119, no. 51 (2022): e2216447119.

"We make “moral” decisions each day (should I stay and help my graduate student with her thesis thereby delaying dinner for my children? And if I do stay, how long is acceptable until the trade-off tips in favor of my children—30 min? An hour? Longer?). There are costs associated with every act, and part of the human condition is that we seek to balance our duties to everyone in our social network.

"Moral judgments, as the above example illustrates, lead to intermediate, compromise solutions. For this reason, the value of moral dilemmas like the trolley problem that yield only binary outcomes is limited to the superficial exploration of normative theories within philosophy—not the underlying mental software driving moral cognition

...

"As a philosophical tool, the trolley problem playfully probes certain (limited) contours of moral decision-making. But, as a methodology imported from philosophy into cognitive science to illuminate moral cognition, the translation is impoverished because it yields only binary, extreme solutions and prevents moral trade-offs or compromise judgments. "

Monday, September 19, 2022

Crowdsourcing organ transplant ethics

 In Slate, an upbeat article about the ethical issues associated with deceased organ allocation and (before that) access to dialysis, and the benefits and difficulties with crowdsourcing the solutions.  

The Kidney Transplant Algorithm’s Surprising Lessons for Ethical A.I.  A more democratic approach to A.I. is messy, but it can work.  BY DAVID G. ROBINSON

This article is adapted from Voices in the Code: A Story About People, Their Values, and the Algorithm They Made, out Sept. 8 from Russell Sage Foundation Press.

" in the world of organ transplants, surgeons and data scientists have an unusual habit of being brutally honest about the human lives behind their work—of inviting others into the impossible choices their field confronts. For better and worse, the organ transplant system is itself a real-life laboratory of more inclusive, accountable techniques for building and using A.I.—approaches that are now being proposed in U.S. and EU legislation that could cover courtrooms, hiring, housing, and many other sensitive domains.

...

"Where did this culture of moral humility—one that’s now shaping the design of a high-stakes A.I. system—come from?

"Collaborative decision-making about hard ethical choices in kidney medicine began before the digital revolution. It began before there were many kidney transplants. "

After the development of dialysis there were..."just a handful of dialysis machines, ...Whom to save? Scribner and his team were inundated with pleas from dying patients and their doctors.

"Faced with this quandary, Scribner and his colleagues chose to do something extraordinary: They shared their moral burden with the Seattle community they served. Rather than pretending that their technical expertise gave them special moral standing, they chose to be morally modest, and to widen the circle. The doctors still decided who was medically eligible for dialysis. But then, they established a second committee, a group of seven laypeople chosen by the local medical society, who would make the non-medical decision of how to allocate the few available slots among the many eligible patients. The committee members were given some basic education about kidney medicine, but weren’t told how to make their moral choices.

They Decide Who Lives, Who Dies” was the headline of a 1962 Life magazine article about this new group. Its members, who were anonymous, were photographed in shadow. A clerical collar can be seen on one. The lone woman of the group, a homemaker, clasps a pair of reading glasses in her folded hands. The article reported that the committee’s approach was based on “acceptance of the principle that all segments of society, not just the medical fraternity, should share the burden of choice as to which patients to treat and which ones to let die.”

"The Life story described some biases that played out on the committee—they favored male breadwinners who had children to support—and it triggered widespread revulsion. A pair of scholars wrote that the committee was judging people “in accordance with its own middle-class suburban value system: scouts, Sunday school, Red Cross. This rules out creative nonconformists … the Pacific Northwest is no place for a Henry David Thoreau with bad kidneys.” The original Life story never mentioned race, but later reporting suggested the committee had been biased in favor of white applicants. The committee only ran for a few years. Other dialysis facilities used different rationing strategies—including first-come, first-served—and in 1972 Congress passed an extraordinary law to provide dialysis at public expense through Medicare to all patients who needed it. That proved to be a humane, if extremely costly, escape route from the rationing problem that Scribner once faced.

"Along with all its faults, I think the Seattle committee also gave us much to admire. It was profoundly, even uncomfortably, honest about the hard choices at the center of kidney medicine. It refused to pretend that such choices were—or ever could be—entirely technical. And it tried, albeit clumsily, to democratize the values inside a complex, high-tech system. The Seattle physicians and their lay colleagues were rationing a scarce supply of dialysis treatments. But even after Congress provided dialysis for everyone, the shortage of transplantable kidneys was destined to spark similar questions, ones we still face today."


HT: Tom Riley

Monday, June 27, 2022

A Forum on Kidneys for Sale in Iran, in Transplant International

 Just published in Transplant International (which is the journal of the European Society for Organ Transplantation), is a paper describing the Iranian market for kidneys in the city of Mashad, and three commentaries on it.  

 Here's the original paper:

Kidneys for Sale: Empirical Evidence From Iran  by Tannaz Moeindarbari and Mehdi Feizi

And here are three short commentaries.

Kidneys for Sale? A Commentary on Moeindarbari’s and Feizi’s Study on the Iranian Model  by Frederike Ambagtsheer1, Sean Columb, Meteb M. AlBugami, and Ninoslav Ivanovski

Kidneys for Sale: Are We There Yet? (Commentary on Kidneys for Sale: Empirical Evidence From Iran) by Kyle R. Jackson, Christine E. Haugen, and Dorry L. Segev

Criminal, Legal, and Ethical Kidney Donation and Transplantation: A Conceptual Framework to Enable Innovation  by Alvin E. Roth, Ignazio R. Marino, Kimberly D. Krawiec and Michael A. Rees

***********

The commentary by Roth, Marino, Krawiec and Rees contrasts the legal Iranian market with the dangerous black markets that operate elsewhere, outside of regular medical institutions.

Here's a recent long article that pulls together much of the discussion on compensation for donors and on sale of kidneys and transplant black markets:

Organ Trafficking, Can the illicit trade be stopped? By Sarah Glazer,  CQ Researcher, June 24, 2022 – Volume 32, Issue 22

HT: Frank McCormick


Thursday, March 10, 2022

David Bennet Sr., who lived for two months with a transplanted pig heart, RIP

 Xenotransplants from pigs are probably here to stay, but are also not quite here yet, and may not be for some time.

Yesterday's NY Times has the story:

Patient in Groundbreaking Heart Transplant Dies. David Bennett Sr. had received a heart from a genetically modified pig, a procedure that may yet offer hope to millions of Americans needing transplants.  By Roni Caryn Rabin, March 9, 2022

"The first person to have his failing heart replaced with that of a genetically altered pig in a groundbreaking operation died Tuesday afternoon at the University of Maryland Medical Center, two months after the transplant surgery.

...

"Mr. Bennett’s transplant was initially deemed successful. It is still considered a significant step forward, because the pig’s heart was not immediately rejected and continued to function for well over a month, passing a critical milestone for transplant patients.

**********

The Times story also made mention of the complicated discussion about organ donation, in this case having to do with the recipient's checkered history, as discussed in this earlier story from the Washington Post:

The ethics of a second chance: Pig heart transplant recipient stabbed a man seven times years ago By Lizzie Johnson and William Wan, January 13, 2022

**********

And while we're thinking of ethical objections, don't forget the pig, or the gene manipulation involved in raising a suitable pig. Here's a rundown from the BBC:

Three ethical issues around pig heart transplants By Jack Hunter, 11 January, 2022

Tuesday, July 27, 2021

Emergency decision making and medical ethics for breakfast

 Saturday morning breakfast cereal (SMBC) has hidden a message for us here:



Friday, March 26, 2021

Ethical payment for research participation

 Discussions of ethical questions turn out to have less math or data than other discussions, but more, well, discussion...  Here's our reply to issues raised in the prior discussion in the preceding issues of the American Journal of Bioethics.

Holly Fernandez Lynch, Thomas C. Darton, Jae Levy, Frank McCormick, Ubaka Ogbogu, Ruth O. Payne, Alvin E. Roth, Akilah Jefferson Shah, Thomas Smiley & Emily A. Largent (2021) Plumbing the Depths of Ethical Payment for Research Participation, The American Journal of Bioethics, DOI: 10.1080/15265161.2021.1895364

"In closing, we’ll respond to Savulescu’s lamentation that our article did not offer “a full economic evaluation of a proposed HIC study such as the UK, with a proposal for a specific amount” (2021). Although we understand this criticism, and considered it ourselves, we were hesitant to make this final move, as there are several different amounts and rationales that could be ethically justified under our framework. Nonetheless, analyzing a particular protocol and the range of payment offers that might be justifiable would be a compelling next step."

Monday, March 1, 2021

Compensating challenge vaccine trial participants: further discussion in the American Journal of Bioethics

 The AJB invites commentaries on its target articles, and the comments on our article on payments in human infection challenge trials have now appeared.  (If I've done this right, you can read them by clicking on the links below.) This is from The American Journal of Bioethics, Volume 21, Issue 3 (2021)

Our target article points out that while much of the medical ethics literature focuses on the claim that payments can subject potential participants, particularly poor people, to undue influence or coercion by being too large, there can be a countervailing concern that payments that are too small can be exploitative, and that this might often be the greater ethical concern.

The commentaries are all brief, but there are nine of them, so let me recommend to my regular market design readers that two that might be rewarding to begin with are those by Julian Savulescu, and by Seán O’Neill McPartlin & Josh Morrison.

Target Article
Open Peer Commentaries
Article commentary
Pages: 32-34
Published online: 22 Feb 2021
OpenURL
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Article commentary
Pages: 35-37
Published online: 22 Feb 2021
OpenURL
  • 2Views
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Article commentary
Pages: 43-45
Published online: 22 Feb 2021
OpenURL
  • 2Views
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Article commentary
Pages: 45-47
Published online: 22 Feb 2021
OpenURL
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