Ludwig Amadeus Minelli (5 December 1932 – 29 November 2025), leader of Dignitas assisted suicide organization

 The Washington Post has the story

Ludwig Minelli, founder of leading assisted suicide group, ends his life at 92.  Dignitas, which Mr. Minelli founded, has helped thousands of people to die, some from countries where assisted suicide is illegal.  By Maham Javaid

 "Ludwig Minelli, who became a leader of the death-with-dignity movement as the founder of Dignitas, a Swiss organization with more than 10,000 members that provides and advocates for access to assisted suicide, died Saturday, ending his life through the process he helped promote. He was 92 and would have celebrated his 93rd birthday on Friday.

...

"Mr. Minelli, a lawyer specializing in human rights, was the general secretary of Dignitas, which since 1998 has helped thousands of people from around the world, including from countries where assisted suicide is illegal, to die. 

...

"Mr. Minelli and his group claimed responsibility for major milestones in the field of assisted death. In 2011 the European Court of Human Rights confirmed the right and freedom of a competent individual to decide on the manner and the time of their own end of life. In 2022, the German Federal Constitutional Court declared a law that made providing professional assistance in suicide impossible in Germany was unconstitutional. The same year, Austria also revoked a blanket prohibition on assisted suicide.

"In recent years, Australia, Canada and New Zealand have shifted their stance on assisted dying.

"Dignitas has participated in nearly 4,200 accompanied suicides since Mr. Minelli founded the group in 1998, the group reported in 2024. More than a third of those people lived in Germany, and there were over 600 people each from France and Britain. The group says it has more than 10,000 members. "

#########

Here is the statement/obituary from Dignitas: Passing of a pioneer and warrior 

Are transplants too scarce, or not scarce enough? A surprising debate about India

 India, now the most populous country in the world, does the third highest number of kidney transplants in the world (although their rate of transplantation per million population is quite low).  So transplants are nevertheless very scarce in India compared to the need, which is the situation worldwide.

Earlier this year, however, a paper by three veteran (non-Indian) transplant professionals who have headed large organizations expressed repugnance for the volume of transplants in India, and the fact that it depends mostly on living donor transplantation (LDT), suggesting it can be viewed as "both alarming and reprehensible."  Their paper's title makes it clear how they view it. 

Domínguez-Gil, Beatriz, Francis L. Delmonico, and Jeremy R. Chapman. "Organ transplantation in India: NOT for the common good." Transplantation 109, no. 2, February, 2025: 240-242. 

"The field of organ transplantation has evolved very differently across the world under the influence of different national healthcare financing systems. Healthcare is, in most countries, financed by taxation and thus through governmental budgets, in combination with private funds, mostly through contributory health insurance systems (eg, Australia, Canada, Europe, New Zealand, South America, and the United States). But across much of Asia, tertiary healthcare services, such as transplantation, are almost entirely dependent on the private finances of individuals. The impressive growth in Indian organ transplantation has been accomplished in for-profit hospitals, which have expanded Indian transplantation into 807 facilities, mostly associated with the major corporate hospital chains.6 Organ transplantation, in a part of the world where one-fifth of all people live, is thus largely not for the common good, but a treatment available for those with ample monetary resources." 

########## 

 This was followed by a firm rebuttal by distinguished Indian transplant professionals.  Their title makes their view equally clear:

Rela, Mohamed, Ashwin Rammohan, Vivek Kute, Manish R. Balwani, and Arpita Ray Chaudhury. "Organ Transplantation in India: INDEED, for the Common Good!." Transplantation 109, no. 6 (2025): e340-e342. 

 "We were deeply concerned by the article “Organ Transplantation in India: NOT for the Common Good” by Domínguez-Gil et al,  which we felt provided an unfairly critical view of the current state of organ transplantation in India. We aim to provide a point-by-point rebuttal based on actual figures and ground-reality rather than tabloid-press articles as cited by the authors.
 

"It is true that in the past 5 y, there has been an extraordinary growth in the number of transplantations in India (more than those achieved over several decades by European countries). While it is natural to be wary of this astronomical increase in transplant numbers, the authors’ assumption that this growth is likely nefarious reflects an outdated western mindset, rather than a true understanding of over 2 decades of massively coordinated effort by the Government of India, transplant professionals and all other stakeholders in the country. 

...

" The development of LDT has been presented with a negative connotation. This shows a scant understanding of the geo-socio-political idiosyncrasies prevalent in the Asian region, and unlike the west, its conventional dependence on LDT.

 ...

"The authors have further confused LDT and deceased donor transplantation with regards to foreigners having access to organs in India. The authors’ accusation of deceased donor organs being preferentially allocated to foreigner is presumptuous at best. The current organ allocation system under the aegis of the Government of India and state-wise organ transplant governing bodies is a very transparent process—and is reserved for Indian nationals.

...

" Transplant tourism being equated with organ commerce is erroneous, the authors’ fail to understand that many poor countries find India a more financially viable destination to get a transplant than countries in the west. Even affordable Governments in the middle east are moving to the east for transplantation, where the ministries have a direct tie-up with transplant units. 

"While it should be conceded that transplantation in India may not be available to all, true social upliftment necessitates broader initiatives beyond just immediate transplant availability: that of addressing poverty. Nonetheless, access to transplants for the underprivileged has greatly improved over the past decade. There are several public sector hospitals in the country that routinely provide transplantation services. In 2023, in the state of Tamil Nadu, 35.1% of all deceased donor renal transplants were performed for free in public sector hospitals (Table 1). 5 While traditionally, the private pay-from-pocket healthcare has been only for those with the resources, the central and several state governments (Tamil Nadu, Andhra Pradesh, Gujarat, etc) sponsor an all-inclusive healthcare state insurance for the poor, which includes transplantation at any approved private hospital in the state; which includes LDT.

####### 

I'm on my way to a conference in Cairo that is motivated in part by concern that healthcare in low and middle income countries has been impeded by some of the international healthcare organizations' lack of understanding or empathy for their situations. 

Funeral expense reimbursement to enhance organ donation and transplantation , by Chan and Sweat

 It's legal to pay funeral expenses for whole-body donors (for research) but not for organ donors for transplantation.  Here's a call to change that:

Chan, A., Sweat, K. Funeral expense reimbursement as a strategy to enhance organ donation and transplantation access. npj Health Syst. 2, 39 (2025). https://doi.org/10.1038/s44401-025-00046-z 

Abstract: We propose amending the National Organ Transplant Act to permit reimbursement of funeral expenses for deceased organ donors, analogous to current practices for whole-body donors. This ethically consistent policy could increase organ donation rates by 9–35%, saving 105,000–419,000 life-years and generating $200–800 million annually in Medicare savings—without commodifying human organs, compromising altruism, or undermining established ethical standards governing organ donation. 

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. "

 

Do we need to worry that surrogacy will be banned in the US? (by the UN??)

  Stat News has a call to prevent surrogacy from being banned, following a recent UN resolution to do just that.

How to keep commercial surrogacy from getting banned
An unlikely alliance working to end surrogacy is gaining power    By Arthur L. Caplan  Oct. 20, 2025
Caplan is head of the Division of Medical Ethics at the NYU Grossman School of Medicine. 

 

Caplan calls for more regulation, which might be a fine idea.  But I don't share his concern that the UN call to ban surrogacy will lead to it being banned in the US. Surrogacy in one form or another has been legalized in every US state (or maybe all but one.)   This is one of those times where it's good that the UN is toothless. 

 

HT: Martha Gershun 

In-game sports betting is something different

 The NYT has the story:

The Seductive, and Risky, Power of Live Sports Betting
In-game betting is predicted to grow to more than $14 billion by the end of the decade. It’s a huge part of the sports gambling industry. Public health officials worry that it could be increasing the risks for gamblers.  By Jenny Vrentas 

"These bets — known as in-game or live betting — have become ubiquitous and are one of the fastest growing areas of the sports gambling industry in the United States. They range from wagers on the result of a game while it is underway to what are known as microbets on events that are resolved quickly, sometimes in a matter of seconds, like the speed of a baseball pitch. Others are on outcomes of random events — will the halftime point total be an odd or even number, for instance. Once you are on the FanDuel or DraftKings mobile apps, there are scrolls and scrolls of bets, worldwide, day or night.

"For betting companies, or sportsbooks, the popularity of live betting is driving rapid revenue growth. Bets during games accounted for more than half the money wagered on FanDuel and DraftKings in recent quarters 

...

"With artificial intelligence being used to automate and accelerate the creation of more betting markets, in-game betting is expected to continue its rapid growth. Revenues from in-game bets could triple by the end of this decade, to more than $14 billion, according to a report released last October by the investment bank Citizens. That is an amount on par with the total revenue generated by the U.S. sports betting industry last year.

...

"Some professional sports leagues now allow ads for sports betting companies to be integrated into the live action of a game broadcast — as opposed to just during a commercial break. Michael Kay, the Yankees play-by-play announcer, or the N.B.A. commentators Charles Barkley and Kenny Smith will offer odds or set up predictions and direct viewers to a sportsbook that sponsors the broadcast and takes the bets. The N.B.A. and Major League Baseball permit up to two of these integrations per game.

"Streaming, too, has enabled new ways for fans to bet while they watch. Last year, the N.B.A. debuted an optional overlay on its livestreaming platform that displays in-game betting odds. Users can tap to click through to a prefilled bet slip in the DraftKings or FanDuel apps. The N.F.L. has gone a step further, allowing its games to be streamed inside sportsbook apps (and still count toward the Nielsen audience ratings).

"The professional sports leagues also benefit from live-betting revenue through their financial stakes in data providers, like Sportradar and Genius Sports. Those data companies sell the real-time data from games that facilitates live bets to sportsbooks, and they get a portion of the sportsbooks’ gambling revenues. The data companies have said that the percentage they take from in-game bets is higher than from pregame bets. (Chris Dougan, a spokesman for Genius Sports, said its partnership with the N.F.L. enabled legal and fair betting on N.F.L. games."

Repugnance and consequence-insensitivity (in connection to opposition to genetically-engineered food)

 There is a well developed literature on repugnance connected to food, and here is a recent, interesting example that focuses on the relationship between consequence-insensitivity and other correlates of moral outrage.

Inbar, Yoel, Sydney E. Scott, and Paul Rozin. "Moral opposition to genetically engineered food in the United States, France, and Germany." Annals of the New York Academy of Sciences (2025). 

 ABSTRACT: "When people are morally opposed to a practice, they often profess to be consequence-insensitive—that is, they say that they think it ought to be prohibited regardless of the risks and benefits. We investigate consequence-insensitive opposition to genetically engineered (GE) food in France, Germany, and the United States. Using nationally representative samples (total N = 1599), we find that most GE food opponents in all three countries are consequence-insensitive (France: 93.1%; Germany: 87.4%; United States: 81.3%). Consequence-insensitive opponents differ from other opponents in other ways consistent with their holding moral beliefs. They are more likely to display other properties of sacred moral values, like quantity insensitivity and universalism. They also see GE food as more personally important, are less willing to consume it, are more in favor of policies restricting it, and are more willing to engage in activism against it."

 

"In their research on moral GE food opposition in the United States, Scott et al. [15] asked par “It is equally wrong to allow some of this to happen as to allow twice as much to happen. The amount doesn't matter” (quantity insensitivity); and “This would be wrong even in a country where everyone thought it was not wrong” (universalism)ticipants three questions that were originally developed by Baron and Spranca [14] for their research on sacred values (which they call “protected values”). Scott et al.’s primary analyses focused on the consequence-insensitivity question, which asked whether GE food “should be prohibited no matter how great the benefits and minor the risks from allowing it.” Likewise, we here focus on the consequence-insensitivity item and test whether responses to other questions theoretically related to sacred values differ between consequence-sensitive and consequence-insensitive opponents. In the current study, we used two other items related to sacred values that were previously used in Scott et al.: “It is equally wrong to allow some of this to happen as to allow twice as much to happen. The amount doesn't matter” (quantity insensitivity); and “This would be wrong even in a country where everyone thought it was not wrong” (universalism). We also added two new exploratory items that were intended to tap moral outrage at the juxtaposition of secular (financial) considerations with sacred values [19]: “I am offended by the idea of putting a monetary price on allowing this”; and “It is morally wrong to put a monetary price on allowing this practice.” For each of these items, we test whether responses differ between consequence-sensitive and consequence-insensitive opponents. If consequence-insensitive opponents are more likely to display quantity insensitivity, universalism, and moral outrage at sacred-secular tradeoffs than consequence-sensitive opponents, then this would provide further evidence that consequence-insensitive opponents moralize GE food more than consequence-sensitive opponents."
 

How to make a racehorse fast? (a new punchline...)

 The old punchline is "don't feed him."  The new punchline is "CRISPR."

Here's a news story from Nature:

First CRISPR horses spark controversy: what’s next for gene-edited animals?  Horses with genomic edits to make them run faster have been banned from polo, but a zoo of CRISPR-edited animals is gaining acceptance in agriculture.  By Katie Kavanagh 

"The horses are clones of the prize-winning steed Polo Pureza, but they have a tweak to myostatin — a gene involved in regulating muscle development — that is designed to quicken their pace. CRISPR was used in fetal fibroblasts (connective tissue cells) to generate embryos through cloning, and then the embryos were implanted into mares.

"The development of these five CRISPR-edited horses ten months ago, by the non-profit research organization Kheiron Biotech in Buenos Aires, is proving controversial among horse breeders in Argentina, where polo is extremely popular, Reuters reported on 30 August.

"Critics are concerned that the technology threatens people’s livelihoods and that it will compromise the tradition of using selective breeding to generate elite horses. The Argentine Polo Association has now banned the use of gene-edited horses in the sport, following the lead of similar organizations such as the International Federation for Equestrian Sports1, which banned the practice in 2019."

"Dark tourism" as a repugnant market in Germany

 NPR's Planet money has a story about tourists visiting the site of Hitler's bunker in Berlin, and about "dark tourism" more generally:

Hitler's bunker is now just a parking lot. But it's a 'dark tourism' attraction anyway By Greg Rosalsky 

"As Germany made intensive efforts to memorialize Nazi victims in the 1990s and 2000s, they also had to grapple with what to do about infamous sites associated with Nazi perpetrators, like the Führerbunker. Over the years, Germans have shown resistance to anything that gives any whiff of memorializing — or even depicting — Hitler and his henchmen.

...

"For years, the German government resisted even recognizing the location of the Führerbunker. Some found visitation of this site distasteful, and they feared any official recognition of it could help it become a kind of shrine for neo-Nazis.

"The Nobel Prize-winning economist Al Roth has developed a concept he calls "repugnant markets." This is when society has a distaste for particular kinds of market activity and may take actions to outlaw or discourage it. Examples he gives include prostitution, buying and selling human organs, ticket scalping, price gouging in the wake of disasters, and eating dog or horse meat. One might add dark tourism of politically sensitive places to Roth's list.

"Heyne says that, despite official reluctance to recognize the location of the Führerbunker and offer anything interesting for tourists to see there, tourists, with the help of guidebooks, came to the site anyways.

...

"And so, in 2006, the Berliner Unterwelten, with the approval of government authorities, erected the information plaque that still stands there today, the only official recognition that this site has historical significance. They chose to make the sign in both German and English. It shows a schematic of the Führerbunker (and a connected bunker known as the Vorbunker) and a timeline of key events at the site. It has a German title, "Mythos und Geschichtszeugnis Führerbunker," or, in English, roughly, the myth and historical record of the Führerbunker.

...

"Perhaps recognizing that many tourists were coming to the Führerbunker and getting disappointed there was nothing there, a Berlin history museum, in 2016, unveiled a full replica of Hitler's bunker that tourists can now go to. (This is kind of similar to other repugnant markets; despite efforts to discourage or even ban a market, demand often proves irrepressible and finds willing suppliers. Think of the failure of Prohibition)."

Demand for surrogacy outstrips supply in England (where commercial surrogacy is illegal)

 Economics in action.

The Guardian has the story:

‘It’s overwhelming’: woman who was UK’s first surrogate closes agency as demand soars
Kim Cotton says laws, little changed since being rushed through in response to her pregnancy in 1985, are ‘dinosaur’  by Jessica Murray 

"Much has changed since Kim Cotton became the UK’s first surrogate 40 years ago, when she was forced to flee hospital on the floor of a car under a blanket, such was the level of media frenzy around her story.

...
"She has spent decades running the surrogacy agency Cots (Childlessness Overcome Through Surrogacy), facilitating more than 1,000 pregnancies. But in September she is closing its doors as soaring demand and a lack of surrogates is making the job more stressful than ever before.

...

"There are now about 400 children a year born through surrogacy to UK parents, up from about 50 a year before 2008, and more than half are now born through international surrogacy arrangements.

"Pro-surrogacy campaigners have blamed the stringent laws in the UK for pushing more people to seek surrogacy arrangements abroad, sometimes in countries with lax or nonexistent regulations. Waiting lists at many British surrogacy agencies are now years long.

“As soon as same-sex parents could go for a parental order, demand doubled, but supplies remained the same,” Cotton says. “There’s also just more infertility around.

...

"The UK’s surrogacy laws have changed little since they were first introduced in 1985, when they were rushed through parliament as a direct response to Cotton’s pregnancy.

"In 2023 the Law Commission published a report with suggested changes, including the creation of a national surrogacy register, and ensuring intended parents in domestic surrogacy arrangements can become parents from the child’s birth.

"Under current laws, intended parents have to apply for a parental order after birth, which can take months and create issues over who makes decisions about the baby’s healthcare in the first weeks of life.


...

“The laws are so antiquated, they’ve not changed since 1985 when I was a surrogate, but it was a kneejerk law that was passed. It’s fossilised. It’s a dinosaur. And it’s just on the back burner now. It’s a damn shame.”

"Campaigners were hopeful the Law Commission report would lead to reform, but the change of government in 2024 has pushed surrogacy to the bottom of the agenda.

"There is also strong opposition from those who are concerned that relaxing the laws could lead to people being coerced into surrogacy by financial need, or wealthy people outsourcing pregnancy because they have the resources to do so.

...

"As well as parental rights from birth, Cotton said she would like to see reform of the expenses system for surrogates. As commercial surrogacy is banned in Britain, advertising for surrogates is not permitted and only “reasonable expenses” are allowed to be paid.

Cotton says this seems to have been accepted as about £15,000-£20,000, although there is no official guidance around what is permitted.

“If the surrogate baby has been living with a couple since the baby was born, how are they going to say, well, no, actually I can’t give you a parental order because you paid a bit too much to the surrogate?” Cotton says. “So we need more clarity.”

Although she is closing down Cots, Cotton is reluctant to leave the world of surrogacy behind completely, and says she will continue to offer advice to people through a surrogacy advice line."

Regulating markets for antiquities, to more effectively compete with black markets (Kremer and Wilkening in JEP)

 Bans on illegally recovering, selling, and exporting archeological antiquities often result in black markets.  Michael Kremer and Tom Wilkening explore how markets might be regulated to be more effective.

Kremer, Michael, and Tom Wilkening. 2025. "Protecting Antiquities: A Role for Long-Term Leases?" Journal of Economic Perspectives 39 (3): 127–48. 

Abstract: In order to preserve cultural patrimony for future generations, most countries ban exports of antiquities. However, this may drive trade underground, particularly in low-income and low-state capacity contexts, and cause irreversible damage to cultural heritage. We argue that complementing export bans with fixed-duration, long-term leases can strengthen incentives for maintenance and revelation of antiquities, while preserving cultural patrimony. Allowing only leases rather than sales limits potential losses from corrupt deals between foreign collectors and government officials. Standardized contracts with set lease lengths, insurance requirements, and care requirements may also be necessary to limit corruption and establish a well-functioning market.

The UN General Assembly issues a call for surrogacy to be outlawed

 A growing number of families are formed by gestational surrogacy, in which a woman bears a child for another couple.  Surrogacy is legal throughout the US, and regulated state by state.

United Nations General Assembly has issued a report saying that surrogacy in all its forms should be regarded as a crime against women, and banned outright.

Report of the Special Rapporteur on violence against  women and girls, its causes and consequences
The different manifestations of violence against women and girls  in the context of surrogacy 

Summary: In the present report, the Special Rapporteur on violence against women and  girls, its causes and consequences, Reem Alsalem, examines the different manifestations of violence against women and girls in the context of surrogacy.

...

Conclusion and recommendations :

69. The practice of surrogacy is characterized by exploitation and violence against women and children, including girls. It reinforces patriarchal norms by commodifying and objectifying women’s bodies and exposing surrogate mothers and children to serious human rights violations. 

70. Considering the above, the Special Rapporteur recommends that Member States and other relevant stakeholders: 

(a) At the international level, take steps towards eradicating surrogacy in all its forms. Pending its abolition, States must take action to prevent further  harm and strengthen the protection of the rights of women and children involved in surrogacy arrangements;

(b) Work towards adopting an international legally binding instrument prohibiting all forms of  surrogacy..." 

 

HT: Kim Krawiec

 

Resuscitation theater ("slow codes"), and Medical Aid in Dying

 Here's an article pointing out that "slow codes" often constitute resuscitation theater, i.e. they are a way to follow bureaucratic directives requiring attempted resuscitation after cardiac arrest in hospitals, when the physicians don't think that would be in the patient's best interest, i.e. when resuscitation would only prolong dying and suffering.  I think this should be part of the discussion of the kinds of "covert" medical aid in dying that takes place even in jurisdictions that don't legally authorize physicians to help shorten the dying process.

McLennan S, Bak M, Knochel K. Slow Codes are symptomatic of ethically and legally inappropriate CPR policies. Bioethics. 2025 May;39(4):327-336. doi: 10.1111/bioe.13396.

Abstract: Although cardiopulmonary resuscitation (CPR) was initially used very selectively at the discretion of clinicians, the use of CPR rapidly expanded to the point that it was required to be performed on all patients having in‐hospital cardiac arrests, regardless of the underlying condition. This created problems with CPR being clearly inadvisable for many patients. Do Not Resuscitate (DNR) orders emerged as a means of providing a transparent process for making decisions in advance regarding resuscitation, initially by patients and later also by clinicians. Under hospital policies in many countries, however, CPR remains the default position for all patients having cardiac arrest in the hospital if there is no DNR order in place, regardless of whether CPR is medically indicated or in the patient's best interests. “Slow Codes” are the delayed or token efforts to provide CPR when clinicians feel CPR is futile or inappropriate. After giving a historical overview of the development and the changing use of CPR, we argue that more attention needs to be given to the cause of slow codes, namely, policies requiring CPR to be performed as the default action while simultaneously lacking implementing interventions such as advance care planning as a routine policy. This is ethically and legally inappropriate, and hospital policies should be modified to allow clinicians to consider whether CPR is appropriate at the time of arrest. Such a change requires a stronger emphasis on early recognition of patients for whom CPR is not in their best interests and to improve hospital emergency planning.

" Proponents of the ‘slow code’ find that intentionally delaying CPR might, in some cases, be a more compassionate alternative to aggressive and potentially futile interventions.

...

"Cardiopulmonary resuscitation is indicated for the patient who, at the time of cardiopulmonary arrest, is not in the terminal stage of an incurable disease. Resuscitative measures on terminal patients will, at best, return them to the dying state. The physician should concentrate on resuscitating patients who were in good health preceding the arrest, and who are likely to resume a normal existence"

Cat food, for big cats in zoos (you could call it pet food)

 Zoos are complicated.

Here's the story from NPR:

A zoo in Denmark asked patrons to donate their pets. Not as attractions, but for food  By Alana Wise
 

"In a post on Facebook, the Aalborg Zoo in Denmark asked people to donate unwanted pets that would be "gently euthanized" and fed to predators in captivity.

...

"The zoo also accepts horses as part of its fodder program.

"The Facebook post quickly became a battleground between commenters who were appalled at the concept of euthanizing healthy pets for animal feed, and those who applauded the zoo for its method of maintaining a practical food supply for its animals.

...

"The Aalborg Zoo says dogs and cats are excluded from the program. Donatable animals are limited to chickens, rabbits, guinea pigs, and horses, it says, adding that this is a practice it has maintained with patrons for years.

"When keeping carnivores, it is necessary to provide them with meat, preferably with fur, bones, etc., to give them as natural a diet as possible," zoo Deputy Director Pia Nielsen said in a statement to NPR.

"Therefore, it makes sense to allow animals that need to be euthanized for various reasons to be of use in this way. In Denmark, this practice is common, and many of our guests and partners appreciate the opportunity to contribute," Nielsen added."

Withdrawals from deceased donor registries

The NYT is standing by its recent stories on deceased organ donation. In the meantime  Newsweek has this story about people who have had second thoughts about deceased donation. (For the record, while it's very important to scrutinize current practices, none of the reported concerns even made me think about withdrawing from the donor registry.)

Mass Exodus From Organ Donor Registries Following Media Coverage  by Joshua Rhett Miller

"Thousands of Americans have removed themselves from organ donor registries following "irresponsible reporting" led by the New York Times, officials said.

The Association of Organ Procurement Organizations, a trade group that represents 46 of the nation's 55 federally designated nonprofit entities that help facilitate donations, accused the newspaper of a "lack of balance and accuracy" in its recent coverage of the problems in the sprawling transplant system.

The letter, sent to three Times editors on Tuesday, cited two articles from July 20, including "A Push for More Organ Transplants Is Putting Donors at Risk," in which reporters Brian M. Rosenthal and Julie Tate detailed rushed or premature attempts to retrieve organs from patients who were, in some cases, still showing signs of life.

A third recent Times item, an op-ed written by three cardiologists in which they argue for a "new definition of death" to help alleviate the backlog of recipients in need of transplants, was not included in the letter. The essay has gone viral on X, with many users commenting it has made them rethink or actively change their status as organ donors. 

 

...

"AOPO claims both articles contained "serious factual inaccuracies," including the trade group attributing "any errors to hospitals" in the story written by Rosenthal and Tate. That phrase wasn't a part of AOPO's response to the newspaper, which subsequently updated the article, according to Tuesday's letter. 

"The main article from July 20 also omitted or misrepresented key facts in some donation cases," the letter continued. "The absence of critical context in the story has fueled massive mistrust in the donation process."

...

"This is the largest spike in registry removals ever recorded in the history of organ donation in the U.S.," AOPO letter reads. "The New York Times' coverage — coupled with a wave of secondary stories by other outlets and widespread, sensationalistic commentary and online reactions — has initiated a wave of panic and fear across the United States."

#########

Earlier:

Sunday, July 20, 2025Organ donation after circulatory death: the NYT recounts some disturbing cases

US Waitlist Registrants who Received Transplantation Abroad

 Here's a recent article about patients waiting for a deceased-donor organ transplant in the U.S. who (instead) received one overseas (and so removed themselves from the U.S. deceased-donor waiting list, from 2010 to 2023. In that period, the total number of deceased donor transplants in the US rose from about 20,000 per year to about 40,000 per year. Around 60 patients a year are removed from the waitlist for this reason, i.e. on the order of one tenth of one percent.

 The tone of the paper is captured by the statement that this is "not universally unethical".

 Landscape of US Waitlist Registrants who Received Transplantation Abroad
Terlizzi, Kelly MS1; Jaffe, Ian S. MD, MSc1; Bisen, Shivani S. MD1; Lonze, Bonnie E. MD, PhD1; Orandi, Babak J. MD, PhD1,2; Levan, Macey L. JD, PhD1; Segev, Dorry L. MD, PhD1; Massie, Allan B. PhD   Transplantation ():10.1097/TP.0000000000005467, July 14, 2025.  

Abstract:

"Background.
Transplant waitlist registrants in the United States may be delisted because of receipt of a transplant abroad. Although not universally unethical, “travel for transplantation” poses risks to posttransplant care. To better understand this phenomenon, this study identifies temporal trends, geographic patterns, and demographic factors associated with cross-border transplantation.

Methods.
Using Scientific Registry of Transplant Recipients data, we identified 818 US waitlist candidates who were removed because of transplantation abroad between 2010 and 2023. We described recipient characteristics overall, by organ, and by top transplant destinations. We used a Cox regression framework to identify characteristics associated with waitlist removal due to transplantation abroad.

Results.
Transplants abroad averaged 58.4 per year. Incidence peaked at 80 transplants in 2017, with an upward trend after 2021. Kidney transplants made up 92.1% of cases. The most common destinations were the Philippines (19.8%), India (16.5%), Mexico (9.4%), China (8.4%), and Iran (4.4%). India and Mexico experienced the smallest drop-off during the height of the COVID-19 pandemic 2020–2021. Most recipients were US citizens (65.0%) or residents (23.5%). Female (adjusted hazard ratio [aHR], 0.520.610.71; P < 0.001) and Black candidates (aHR, 0.120.180.26; P < 0.001) were less likely to travel abroad compared with Asian candidates (aHR, 5.927.108.52; P < 0.001). Nonresidents (aHR, 6.708.6911.26; P < 0.001) and, among registrations in 2012 or later, nonresidents who traveled to the United States for transplantation (aHR, 27.2738.9155.50; P < 0.001) had a greater chance of undergoing transplantation abroad.

Conclusions.
Understanding patterns of international travel for transplantation is key not only for preventing resource drains from destination countries but also for providing adequate posttransplant care for recipients."

Cellular agriculture points the way to removing killing from the food chain

Here's a story from the Washington Post about growing fish-flesh and meat from cells in a lab. The story emphasizes sustainability, but this may be a process that could one day return fish and poultry to the diets of ethical vegetarians. (Of course this is one of those things that could be coming tomorrow and always will be...)

No bones, no scales, no problem: The first lab-grown salmon sold in the U.S.  Wildtype’s cell-cultivated salmon is the first seafood to earn FDA approval, marking a significant milestone for the alternative protein industry.  By Allyson Chiu

"The Coho salmon, pinkish orange and streaked with lines of white fat, wasn’t wild-caught in Alaska or farmed in Chile. It comes from cells grown in tanks at a former microbrewery in San Francisco, and in late May it became the first cell-cultured seafood to receive safety approval from the U.S. Food and Drug Administration.

...

"At least two lab-grown chicken products have previously gotten the FDA’s green light. But the okay for the salmon, made by California-based Wildtype, marks a significant milestone for the alternative protein industry, which has been working to produce substitutes for traditional meat and fish that can help meet the world’s growing demand for food while minimizing environmental and climate impacts. "

The repugnance of slavery (1847)--an open letter

  The civil war was preceded by a schism among Northern and Southern Baptists over the institution of slavery.  The recent rediscovery of an original document puts that story in the news.

The NYT has the story:

Discovery of 178-Year-Old Baptist Antislavery Document Elates Faith Leaders.  The handwritten resolution, signed by 116 Baptist ministers from Massachusetts who called slavery “repugnant,” was thought to have been lost.  By Aishvarya Kavi

"The scroll was handwritten in 1847, just two years after Baptists in the United States split, with the Southern congregations breaking off over their Northern counterparts’ condemnation of slavery.

"Using forceful language, 116 Baptist ministers in Massachusetts had signed their name to what they called “A Resolution and Protest Against Slavery,” condemning the system as “entirely repugnant.”

...

"At the time, the increasingly forceful stance by the Baptist ministers in Massachusetts against slavery reflected the widening divide between the North and South

...
"That national breach would become so wide that, 14 years after the document’s signing, it would lead to the Civil War."

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This offers a ray of hope to those of us who today sometimes sign open letters.

Explaining economics can change the evaluation of policies, by Elias, Lacetera and Macis

 Perhaps economists should get involved in the discussion of public policies during political campaigns...

Is the Price Right? The Role of Economic Trade-Offs in Explaining Reactions to Price Surges
Julio Elías, Nicola Lacetera , Mario Macis    Management Science
Published Online:4 Jul 2025https://doi.org/10.1287/mnsc.2024.04555 

Abstract: Public authorities often introduce price controls following price surges, potentially causing inefficiencies and exacerbating shortages. A survey experiment with 7,612 Canadian and U.S. respondents shows that unregulated price surges raise moral objections and widespread disapproval. However, acceptance increases and demand for regulation declines when participants are prompted to consider economic trade-offs between controlled and unregulated prices, whereby incentives from higher prices lead to additional supply and enhance access to goods. Moreover, highlighting these trade-offs reduces polarization in moral judgments between supporters and opponents of unregulated pricing. Textual analysis of responses to open-ended questions provides further insights into our findings, and an incentivized donation task demonstrates consistency between stated preferences and real-stakes behavior. Although economic trade-offs do influence public support for price control policies, the evidence indicates that even when the potential gains in economic efficiency from unregulated prices are explicit, a significant divide persists between the utilitarian views that standard economic thinking implies and the nonutilitarian values held by the general population.

 

"Overall, therefore, we document widespread opposition to sudden price surges, motivated in large part by moral and ideological considerations. However, explicitly describing possible economic trade-offs between policy regimes does affect people’s reactions by making them more open to letting prices move freely. This result suggests that people do not immediately consider efficiency or equilibrium considerations when reacting to and expressing a judgment about price surges. When considerations about economic efficiency are missing, moral reactions are highly polarized; when economic trade-offs are explicit, views tend to converge. However, the fact that most respondents still support price control policies in this case suggests that this position derives from normative concerns and not necessarily from a lack of consideration for equilibrium effects and efficiency implications."