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

AI assisted job applications (and application screening)

 NBC news has the story:

AI is supposed to make applying to jobs easier — but it might be creating another problem
Companies have touted new AI technology that allows users to apply to thousands of jobs per day, flooding job openings with resumes.  By Sophia Pargas

"With the help of new AI software, applicants can now revise their resumes and cover letters, receive live interview scripts and launch chatbots to submit thousands of applications almost instantly.

...

"LazyApply, Simplify and AI Hawk are all AI services that launch assistants to help collect applicant information and submit automated job applications through sites like LinkedIn and Indeed. Using the tools, job seekers can save hundreds of hours — and apply to up to thousands of jobs a day, according to the services.

"AI Apply, which claims its users are “80% more likely to get hired,” offers tools like a cover letter and resume builder, an auto-apply feature, an interview practice generator and a specialized interview buddy. A premium membership starts at $38 a month, according to the website — a cost AI Apply notes is much lower and more accessible than the cost of a career counselor.

...

"According to the company’s respective websites, OfferGoose has helped applicants land over 17,000 job offers, and AI Apply has over 340,000 “freelancers and job seekers” using the service.

"Nevertheless, many companies have enlisted additional safeguards to detect the use of AI. Some employers now require e-confirmation codes to submit applications and prevent automated submissions. Others have added prompts asking AI bots to use specific words like “banana” in responses to catch chat-generated application answers, according to longtime job recruiter and tech agency director of talent Mike Peditto.

"But job seekers are not the only party using AI in the application process, according to a recent University of Washington study. The researchers estimated that “99% of Fortune 500 companies are already using some sort of AI assistance when making hiring decisions,” and found that resume-screening tools have an incredible bias toward white, male applicants — with the large language models favoring white-associated males roughly 85% of the time and disadvantaging Black males in “up to 100% of cases.”

"The use of AI by both applicants and employers has created a distinct dynamic, in which applicants are using AI, but are also reticent about employers screening them with AI."

Income inequality, risk, and repugnance by Hauge, Kverndokk, and Lange

Two recent papers by  Karen Hauge, Snorre Kverndokk, and Andreas Lange report on the roles played by inequality and risk in causing repugnance to markets.

First, an experiment, motivated by a hypothetical market in kidneys (expressed in abstract terms), that finds that income inequality boosts repugnance to trade.

Hauge, Karen E., Snorre Kverndokk, and Andreas Lange. "Opposition to markets: Experimental evidence." Journal of Economic Behavior & Organization 227 (2024): 106743.

Abstract: We experimentally investigate reasons for opposing market institutions. The experiment shows that opposition to implementing market institutions varies by background characteristics and shows that distributional concerns are a reason for opposing trade institutions. We find no evidence that the opposition to trade is due to risk preferences or paternalistic motives. A main driver of the opposition to trade is the information about background conditions: veils of uncertainty increase the support for the trade institution.

"This paper reports experimental evidence to better understand potential opposition to market institutions, i.e. for allowing people to trade. For this, we abstract from repugnancy concerns that relate to the specific characteristics of the good or service in question, and rather reduces the setting to the payoff dimension and thus the involved risks and distributional concerns. While we use a neutral framing, organ trade, in particular, trade in kidneys, inspires the set-up of the experiment. Trading kidneys for payment is illegal worldwide, apart from in Iran.1 While it is obvious that persons with kidney issues would substantially benefit from a transplant, healthy donors expose themselves to risk (e.g., Lentine and Patel 2012). Currently, there is not a large income gap between donors and recipients in the US (Gill et al., 2012). Nevertheless, studies suggest that - at a given price - the poor would have larger incentives to donate and therefore, are more exposed to potential risks (Moniruzzaman, 2012; Parada-Contzen and Vásquez-Lavín, 2019) and thus potentially more vulnerable in terms of Satz (2010).2 To illustrate this in the experiment, we vary both the initial income of players (rich/poor) as well as their condition (healthy/sick) which combined affect their potential prospects with and without trade. 

...

"In our experiment, a share of 20 % of respondents across all treatments oppose the trade institution although it is constructed such that personal expected payoff is unaffected or improved. We find that the major reasons individuals vote against trade are the unfair distributions of gains from trade. Importantly, the opposition towards trade is partly self-serving: opposition is lower among those that benefit the most from implementing a market institution. Specifically, we find a significantly smaller opposition to trade institutions when participants are behind the veil of ignorance and do not know their income level, their (abstractly defined) health condition, and thus, how trade affects their payoff. Similarly, we find that distributing gains from trade more evenly, thus benefiting the poor to a larger extent, reduces opposition to trade among the poor."

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And here's a related survey study:

Hauge, Karen Evelyn, Snorre Kverndokk, and Andreas Lange. "On the opposition to market institutions on moral grounds." Humanities and Social Sciences Communications 11, no. 1 (2024): 1-8.

Abstract

"From a liberal viewpoint, voluntary trade appears to be something that should meet universal approval. If no one is obliged to trade, establishing a market institution could only make all better off. Nonetheless, specific market institutions meet substantial skepticism and criticism. This paper extends the extant literature by surveying the moral opposition towards trade in multiple dimensions and linking this to policy support measures. We provide survey results on moral opposition to trade in organs, sex services, surrogate mothers, trade in carbon permits, goods produced in poor countries, and food from countries where people suffer from hunger. These cover the potential reasons for opposing trade institutions: moral concerns, paternalism regarding risk-taking, and distributional concerns. Beyond this, we measure support for policies on unemployment benefits, risk prevention, equality goals within society, and redistribution. The survey of Amazon Mechanical Turk workers from the U.S. reveals significant moral opposition to trade in diverse dimensions. About a third of the participants strongly oppose trade in body items, sex services, and food imports from countries where a large proportion of the population suffers from hunger and malnutrition. Fewer participants strongly oppose trading CO2 permits, importing from developing countries, or allowing surrogate mothership. Besides other correlates (e.g., gender, education, being conservative), individuals’ attitudes towards imposing risks on others are identified as an important correlate of the opposition to trade for all the contexts of trade: those who are averse to exposing others to risk for their own advantage are more likely to oppose trading institutions. This measure of social preferences also relates to support for policies on risk prevention, equality goals within society, and redistribution. We discuss potential mechanisms behind this explanatory power of the newly identified measure."

Arguments against paying for plasma and other Substances of Human Origin (SoHO)

 Substances of Human Origin (SoHO) have a growing, often lifesaving role in modern medicine, from breast milk for premature babies, to kidneys for transplant, to blood and blood plasma, which the World Health Organization categorizes as an essential medicine for a wide variety of ailments and injuries.  However concern for protecting the donors of SoHO from exploitation has led to a considerable debate about whether donation must always be uncompensated, and motivated purely by altruism.
 

Two important cases are donation of kidneys and of blood plasma. Payment to donors of kidneys for transplant is banned almost everywhere, but a few countries (among which the U.S. is prominent) allow payment to plasma donors. Kidneys are in short supply, so patients with kidney failure very often die prematurely without receiving a transplant, but among high and middle income countries almost no one is today dying from a shortage of plasma and plasma products.  That isn’t because countries that don’t pay plasma donors generate sufficient supply for their domestic needs, it is because they can import plasma pharmaceuticals from countries that do pay donors, chiefly the U.S. which exports tens of billions of dollars of plasma products annually.
 

Here's an article arguing that payment for plasma and other SoHOs is always and everywhere wrong and should be stopped. (The  authors seem to agree with the WHO that countries should raise enough plasma domestically from unpaid donors, although no country has yet managed to do this.)  Furthermore, they suggest that companies that collect and process plasma must be nonprofits.

Prevention of Trafficking in Organs, Tissues, and Cells by Martin, Dominique E. PhD1; Capron, Alexander M. LLB2; Fadhil, Riadh A. S. MD3; Forsythe, John L. R. MD4; Padilla, Benita MD5; Pérez-Blanco, Alicia PhD6; Van Assche, Kristof PhD7; Bengochea, Milka MD8; Cervantes, Lilia MD9; Forsberg, Anna PhD10; Gracious, Noble MD11,12; Herson, Marisa R. PhD1; Kazancioğlu, Rümeyza MD13; Müller, Thomas PhD14; Noël, Luc MD15; Trias, Esteve MD16; López-Fraga, Marta PhD17 Transplantation, October 22, 2024. | DOI: 10.1097/TP.0000000000005212
 

“It is essential that all national laws “concerning the donation and human application” of human organs, tissues, and cells, as well as all derived therapies, conform to the principle of financial neutrality, prohibiting financial gain in the human body or its parts.9,70 Healthcare professionals, service providers, and organ, cell, and tissue procurement organizations, as well as other industry stakeholders involved in processing, manufacture, storage, and distribution of SoHOs and SoHO-based therapies, are all entitled to “reasonable remuneration” for their work and coverage of the costs associated with various sector activities.66,71 However, what may be considered a reasonable and proportionate remuneration in this context is ill defined. There have been reports of service providers and professionals generating disproportionate profits from such activities, creating potential financial conflicts of interest in service provision and potentially violating ethical norms and legal standards prohibiting trade in SoHOs.30
 

“Development of innovative therapies using human cells and tissues has increased, with the potential therapeutic value of these resources spurring commercial interests that, in some cases, has led to practices in which donated SoHOs are treated as commodities.30,72–75 Furthermore, some SoHOs may undergo substantial processing, resulting in these therapies being regulated outside the regulatory framework governing the transplantation of organs, tissues, and cells as such, and rather being considered as medicines, where commercial profits are expected and guide the production and distribution activities.74,75
 

“Mechanisms should be developed to ensure that strategies used in donor recruitment, which may involve actual or perceived financial incentives, are routinely disclosed and open to scrutiny.70 Transparency of practice is also required to enable scrutiny of the fees charged to cover costs of procuring, processing, storing, manufacturing, and distributing cells, tissues, and SoHO-based therapies and to assess the potential influence of financial interests on decision-making about the use of SoHOs in particular SoHO-based therapies, or distribution of SoHO-based therapies.74 These measures would furthermore help to facilitate equitable access to treatments for all patients.21
…
Box 1, first recommendation
“Recommendations for action to prevent trafficking in SoHOs
•    1. All countries should establish laws that prohibit payment for donation of SoHOs, trafficking in SoHOs, and trafficking in human beings to obtain SoHOs.
o    a. Legislation should prohibit activities that make the human body or its parts a source of financial gain exceeding the recovery of the costs of obtaining, processing, storing, and distributing those parts or the products made from them and of ensuring the sustainability, safety, and quality of donation and transplantation systems.”

##########

They also suggest that there is widespread human trafficking in SoHO, although they acknowledge that there isn’t a lot of data to support this:

“since 2010, there have been few empirical studies of organ trafficking, with more recent studies often consisting of qualitative interviews or surveys with individuals who participated in organ trafficking or were victims of human trafficking for organ removal several years earlier.7,32,52 Legal case analyses have focused primarily on seminal cases that detail activities that occurred in the early 2000s.33,38 Much of what is known about current trafficking activities is gleaned from sporadic media reports, which make clear the global prevalence of organ trafficking.”

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Earlier:

Wednesday, August 28, 2024  WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood, by Krawiec and Roth

Monday, April 22, 2024 Plasma donation in the EU: compensated and uncompensated

Saturday, November 4, 2023  The EU proposes strengthening bans on compensating donors of Substances of Human Origin (SoHOs)--op-ed in VoxEU by Ockenfels and Roth

Abortion on the ballot

 And in other news, we're in new territory for the American experiment.  This will surely have effects on controversial markets (among other things).  An interesting feature of yesterday's vote was that many states preserved or restored abortion rights. 

CNN has the still-unfolding story: 

7 states vote to protect abortion rights, while efforts to expand access in Florida and South Dakota fail by By Amy O’Kruk, Annette Choi, Lauren Mascarenhas, Kaanita Iyer and Piper Hudspeth Blackburn, CNN, Updated 8:22 AM EST, Wed November 6, 2024

"More than two years after the US Supreme Court overturned Roe v. Wade and ended the federal constitutional right to an abortion, voters in 10 states cast ballots on whether to cement reproductive rights in their state constitutions.

"Measures to protect abortion access in Arizona, Colorado, New York, Maryland, Missouri, Montana and Nevada will pass, CNN projects. In New York, Colorado and Maryland, where abortion is legal at least up to the point of viability, the measures will maintain current abortion access. In Missouri, the amendment will remarkably expand access to abortion, which is currently banned with no exceptions for rape or incest. Similarly in Arizona, the amendment is expected to overturn the state’s ban on abortions 15 weeks into pregnancy.

"But a Florida amendment to protect the right to an abortion up to the point of viability will fail, CNN projects, with the amendment falling short of the 60% voter threshold for passage. The state’s six-week ban will remain in place.

"And South Dakota’s ban on abortions with an exception to save the life of the mother will hold as a majority of voters cast a ballot against an initiative to legalize abortion – with regulations – during the first and second trimesters of pregnancy.

"Voters in Nebraska also weighed in on the issue as they faced dueling measures on the ballot: One that would invalidate the state’s 12-week abortion ban, which makes exceptions for sexual assault, incest and medical emergencies, and the other to uphold the restriction."

Gambling as a public health issue (Lancet)

 Here's a warning about gambling from the Lancet:

The Lancet Public Health Commission on gambling   October 24, 2024

"Executive Summary: Gambling is not an ordinary kind of leisure; it can be a health-harming, addictive behaviour. The harms associated with gambling are wide-ranging, affecting not only an individual's health and wellbeing, but also their wealth and relationships, families and communities, and deepening health and societal inequalities. By examining these harms, the Commission unveils the intersections between the social, commercial, legal, and political determinants of health. The Commission sheds light on the increasingly complex commercial ecosystem for gambling and its digital transformation which offer unparalleled capacities for gambling. The Commission calls on governments and policymakers to treat gambling as a public health issue—just as for other addictive and health-harming commodities, such as alcohol and tobacco—and provides recommendations to prevent and mitigate the broad range of harms associated with gambling.

Payments for election-related actions

 Buying votes is illegal, but other election related offers may seem odd but are legal.  

The Guardian has the story.

‘There are certain things that we don’t allow to be sold’: why vote buying in the US is illegal. by George Chidi

"Last week, Tesla CEO Elon Musk offered a $47 payment to people who refer registered voters in swing states to sign a petition supporting free speech and gun rights. The billionaire’s political action committee is using the petition to gather contact information in a last push for support of Donald Trump’s campaign.

"Responding to that offer, card game company Cards Against Humanity, long a Musk foe, announced it will pay up to $100 to each person who didn’t vote in 2020, who apologizes for that, makes a plan to vote and posts in public the phrase “Donald Trump is a human toilet.” Residents of swing states can earn the most money.

"The card game company told the New York Times that more than 1,150 people had been paid through the program as of Wednesday afternoon.

"Vote buying in illegal under US law, but Cards Against Humanity’s site claims that it is “exploiting a legal loophole to pay America’s blue-leaning non-voters”.

"The Guardian talked with Richard Hasen, a professor specializing in election law and director of the Safeguarding Democracy Project at the UCLA School of Law, about the legality – if not the propriety – of these offers.

Q:"I want to get a sense from you about where the line is. What’s legal and what’s not? What are we looking at with Trump buying $100 worth of groceries for somebody at the store, or Musk with this $47 thing, or the reaction by Cards Against Humanity to that? How much of this is legal, and how much isn’t?

A: "It’s all legal. The Cards Against Humanity one comes closest, but there’s a pretty bright line. You cannot pay someone to vote, to register to vote, to vote in a particular way in a federal election. Elon Musk is not paying anyone to vote. He’s paying for leads. I mean, if he’s actually going to pay people to vote, that’s a different question.

Italy criminalizes surrogacy from abroad

 Italy has banned its citizens from accessing surrogacy in other countries where it is legal.  It will be interesting to see how they enforce this. (But of course gay couples will have fewer opportunities to skirt the law than couples who could pretend to have had a pregnancy..)

The NYT has the story:

Italy Criminalizes Surrogacy From Abroad, a Blow to Gay and Infertile Couples. The new law was pushed by the party of Giorgia Meloni, Italy’s conservative prime minister. by Emma Bubola

"Italy passed a law on Wednesday that criminalizes seeking surrogacy abroad, a move the country’s conservative government said would protect women’s dignity, while critics see it as yet another crackdown by the government on L.G.B.T. families, as the law will make it virtually impossible for gay fathers to have children.

"Surrogacy is already illegal in Italy. But the government of Prime Minister Giorgia Meloni has vowed to broaden the ban to punish Italians who seek it in countries where it is legal, like in parts of the United States."

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Earlier:

Thursday, August 22, 2024  Surrogacy under continued attack in Italy

Medical aid in dying comes up for a vote in England

 The upcoming vote on legalizing medical aid in dying in England and Wales has attracted controversy along lines that will be familiar to readers of this blog, concerning both fundamental values and slippery slopes.  But a comment by British Cardinal Vincent Nichols introduces an argument that I hadn't heard stated so clearly before, about the religious significance of suffering.  But first, here's the background, from the BMJ.

MPs set for historic vote on bill to legalise assisted dying in England and Wales,  by Clare Dyer, 07 October 2024  BMJ 2024;387:q2191

"A bill to legalise assisted dying for terminally ill people in England and Wales is expected to be introduced in the House of Commons on 16 October.

...

"Hundreds of terminally ill people from the UK have travelled to the Swiss clinic Dignitas to end their lives. But friends and relatives who help them are at risk of prosecution for assisting a suicide, which carries a maximum prison sentence of 14 years.

...

"Surveys of public opinion show that about two thirds of the public support allowing assisted dying. The BMA dropped its opposition in 2021 to take a neutral position on a change in the law."

##########

And here is a story about objections from a religious point of view, from the senior Catholic official in England.

UK’s top Catholic bishop urges faithful to lobby MPs to oppose assisted dying  by Hayden Vernon Sat 12 Oct 2024 

"The archbishop of Westminster continued: “The suffering of a human being is not meaningless. It does not destroy that dignity. It is an intrinsic part of our human journey, a journey embraced by the eternal word of God, Christ Jesus himself. He brings our humanity to its full glory precisely through the gateway of suffering and death.”

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Earlier:

Friday, March 1, 2024

Medical aid in dying--the ongoing debate in Britain

Kim Krawiec interview about WHO demands for national self sufficiency in blood donation and kidney exchange

 The University of Virginia takes note of the recent Krawiec & Roth paper I blogged about in August.

Here is their interview with Kim about the paper:

WHO Stifles International Blood and Organ Donations, Argue Professors. Professor Kimberly Krawiec, Nobel Prize Winner Alvin E. Roth of Stanford Argue World Health Organization Policies Need Revision

Here are the first two Q&As

"What motivated you to critique the WHO principles of self-sufficiency and nonremuneration in organs and blood? ​

"The severe shortage of both blood products and transplantable organs, especially kidneys, was our motivation and has motivated much of our other work, both together and separately. In the United States alone, the organ transplant waiting list is approximately 100,000 people, and if current trends continue, it will only grow in the coming years.

"Shortages of blood products present a similar challenge. Although wealthy countries are typically able to satisfy domestic whole blood needs, the vast majority of low- and middle-income countries (LMIC) are not. As a result, in many LMIC, shortages of blood for transfusion contribute to maternal death, death from traffic accidents and complications from childhood anemia. Moreover, even wealthy countries experience seasonal shortages of whole blood or deficiencies in some blood components, such as platelets, which are harder to collect and have a shorter shelf life.

The shortage of plasma-derived medicinal products (PDMPs) is particularly severe and entirely preventable. PDMPs are life-saving treatments for multiple acute and chronic conditions for which there are no alternative treatments. Yet these life-saving therapies are unavailable to much of the world’s population. The United States, one of the few countries to pay plasma donors, supplies 70% of the world’s plasma needs, with Germany, Austria, Hungary, Czechia and Latvia (which also permit some form of payment for plasma donors) supplying another 20% of the world total. In other words, a handful of countries supply plasma to the rest of the world, including other wealthy countries. Meanwhile, LMIC who can neither collect and process their own nor afford to purchase blood products on the open market (or are prevented from doing so under the terms of the foreign aid that supports their health system) simply do without, to the detriment of their citizens.

"How do current WHO policies on organ and blood donation contribute to this problem?

"WHO policy mandates both national (or sometimes only regional) self-sufficiency and an absence of remuneration for both blood products and transplantable organs — what we refer to in the paper as “the twin principles.” These twin principles are unhelpful separately and unworkable together. Their effect on blood products is particularly stark — no country that fails to compensate donors is self-sufficient in plasma collection and few LMIC collect sufficient supplies of whole blood.

"The self-sufficiency mandate presents a real hurdle to progress in transplantation, especially for smaller countries and LMIC. This is especially the case because some of the most exciting and promising developments for increasing the availability of transplants have been in kidney exchange, a mechanism that leverages in-kind exchange, rather than financial compensation, to encourage and facilitate donation among those with willing but incompatible partners. But kidney exchange works best when a large pool of patient-donor pairs can engage with one another. So, requiring that transplantation be contained within national boundaries unnecessarily limits access to transplants that could be achieved only by cross-border exchange."

Medical Aid in Dying Laws in the U.S.

 JAMA has a review of the current state of medical aid in dying in the 12 U.S. jurisdictions (if Delaware proceeds) that now allow it.

Medical Aid in Dying Laws: More Accessible in More States by Thaddeus Mason Pope, JD, PhD, JAMA. 2024;332(14):1139-1140. doi:10.1001/jama.2024.15925

"Delaware may soon become the 12th US jurisdiction to authorize medical aid in dying. The Ron Silverio/Heather Block End-of-Life Options Law1 becomes a statute as soon as the governor acts and takes effect once the Delaware Department of Health and Social Services promulgates regulations to implement the statute. Delaware could follow 11 other US jurisdictions that have authorized medical aid in dying; more than 15 000 patients have received prescriptions for medical aid in dying since 1998 in California, Colorado, Hawaiʻi, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, Washington, and Washington, DC.

...

"Medical aid in dying has become an increasingly prominent end-of-life option. More than 20 states considered new medical aid in dying legislation in 2024, and most of the 11 jurisdictions that previously authorized medical aid in dying have amended their original statutes during the past 5 years (eTable in the Supplement).2-6 When enacting or amending medical aid in dying statutes, state policymakers have been carefully recalibrating the balance between safety and access

...

"Medical aid in dying is only available to terminally ill adults with decision-making capacity. They must have an “incurable and irreversible illness” with a prognosis of 6 months or less. If patients can navigate the other eligibility requirements and safeguards, they can get a prescription for lethal medications that they might later self-ingest to hasten their death.6

"Hospice and palliative care are often sufficient to address the suffering of patients, and one-third of those who receive medical aid in dying prescriptions never obtain them from the pharmacy or ingest them.3,4 Most of the remaining patients administer the prescriptions by mixing the powdered drugs with 2 oz to 3 oz of apple juice or push a plunger on a feeding or rectal tube. The patients fall asleep within minutes and usually die within an hour. There is never intravenous administration of the prescriptions or clinician- or third-party administration of the prescriptions.

...

"The Delaware end-of-life options law would require the patient to make 3 requests, 2 of which must be separated by at least 15 days.1 A waiting period has been a requirement in all jurisdictions that have authorized medical aid in dying. However, significant evidence showed that many patients either died or lost decision-making capacity before expiration of the waiting period.4 Many states (California, Colorado, Hawaiʻi, New Mexico, Oregon, and Washington) have either shortened their waiting periods or permit the waiting period to be waived when the patient is likely to die or lose decision-making capacity.

"The Delaware end-of-life options law would be limited to residents of Delaware1; however, for nonresidents, Delaware residency can be established by renting an apartment in Delaware.4 Residency requirements remain an additional hurdle in a long list of obstacles that terminally ill patients must navigate to become eligible. Within the past 2 years, both Oregon and Vermont removed their residency requirements.2,4,6 And the constitutionality of New Jersey’s residency requirement is being challenged in federal court.6 Nationwide, many bills proposed in 2024 omitted residency preconditions.

...

"Commentators regularly express concerns about the use of medical aid in dying in Canada7 and in Europe. It is important to protect vulnerable populations from coercion, duress, and inadequately considered choices; patients should not be steered toward choosing to request medical aid in dying. In addition, the adverse effects of orally ingested medications must be mitigated.4 In California, SB 1196 would have probably solved that problem by permitting (self-administered) intravenous administration of the end-of-life prescriptions. However, any change that would allow intravenous administration and other new and imminent expansions for medical aid in dying raise their own set of novel challenges for US clinicians.

"Given the number of bills and other indicators of interest, medical aid in dying is likely to be authorized in more states over the next few years, and the use medical aid in dying is likely to increase with more accessible terms and conditions. Although medical aid in dying continues to be used by less than 1% of dying patients,2 it is becoming a more integral part of end-of-life care."

IV fluid shortages in the U.S.--perhaps we should allow international imports?

There's a hurricane-induced shortage of intravenous (IV) fluid.  Maybe we should import some? (But...international borders...)

An obstacle is that FDA approval of the factories is usually needed, but can be (and in the past has been) suspended, to allow imports from places that do their own high quality inspection (like Australia and Ireland in 2017--I guess it's good that the labels are in English) .  

More generally, after the Covid pandemic we learned of the fragility of supply chains that have concentrated overseas sources (like surgical masks from Wuhan).  The reaction has been to onshore more production. But concentrated domestic production also makes for fragile supply chains, and being able to diversify to overseas producers could strengthen them.

Statnews has the story:

White House should declare national emergency over IV fluid shortages caused by Helene, says hospital group. Hurricane Helene shuttered a Baxter plant that manufactures 60% of IV solutions for the U.S.  By Brittany Trang 

"Amid Hurricane Helene shuttering a major IV solution manufacturing plant and Hurricane Milton now barreling toward other IV manufacturing facilities in central Florida, the American Hospital Association on Monday asked the Biden administration to declare a shortage of IV solutions and invoke national emergency powers to ease the crisis. 

'In late September, Hurricane Helene shut down a Baxter plant in Marion, N. C., which manufactures approximately 60% of the IV solutions for the U.S. Both Baxter and “all other suppliers” of IV solutions have restricted how much their customers can order and have stopped taking new customers, AHA president Rick Pollack wrote in the organization’s letter to Biden. As a result, hospitals have declared internal shortages and restricted IV use. 

...

"In addition, the letter asked for the government to declare a national emergency and public health emergency so that Medicare and Medicaid rules around IV infusions can become more flexible, and to invoke the Defense Production Act to expand the production of IV solutions and bags. The AHA also suggested the government put the Federal Trade Commission and Department of Justice on alert for price gouging during the shortage.

Another step the FDA could take is to allow the importation of IV bags from other countries,* as it did when Hurricane Maria shut down Baxter’s Puerto Rico-based IV saline plants in 2017. That shortage mostly affected small IV bags. According to Vizient, a health care performance improvement company, the North Carolina Baxter plant is largely a producer of large IV bags, including saline, dextrose, and Ringer’s lactate solutions.

#####

*In 2017: "To address a shortage of intravenous solution bags exacerbated by Hurricane Maria, the Food and Drug Administration has granted permission for a health supply company to import certain products to the United States from Australia and Ireland."

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Related:

Wednesday, August 28, 2024

WHO Says Countries Should Be Self-Sufficient In (Unremunerated) Organs And Blood, by Krawiec and Roth

Technology and crime: cloning giant sheep

 There are things you can go to prison for that wouldn't have been possible to do not long ago.

The Washington Post is on the case:

Rancher sentenced to 6 months in prison for illegally cloning giant sheep. Arthur “Jack” Schubarth, 81, previously pleaded guilty to creating giant hybrid sheep via illegally imported genetic material.  By Kyle Melnick

"The Montana rancher’s illegal scheme began in 2012, when he paid for his son to hunt one of the world’s largest sheep species in Kyrgyzstan, court documents say. Arthur “Jack” Schubarth then used parts of the sheep in the following years to breed an even larger hybrid species and sell those animals to hunters.

"Now, Schubarth is set to spend six months in prison for the ploy after pleading guilty to two felony wildlife counts in March. Both counts stemmed from violations of the Lacey Act, a federal conservation law that prohibits interstate sales of falsely labeled animals and sales of animals to states where they’re illegal to own.

...

"Much of the scheme played out at Schubarth’s 215-acre ranch in Vaughn, Mont., where he bred and sold mountain sheep, mountain goats and similar breeds. Schubarth paid for his son to take multiple trips to Kyrgyzstan in 2012 and 2013. In January 2013, Schubarth’s son brought back viable tissue from a Marco Polo argali, a rare and large species native to central Asia, but didn’t declare the materials when he reentered the United States, court documents allege.

...

"Schubarth sought to create an even more valuable species, according to prosecutors. Sheep with larger horns and bodies are worth more to hunters, including at private shooting preserves, where hunters pay to pursue captive game.

...

"Schubarth agreed to a contract with a cloning facility in 2015, and by late the following year, he had 165 cloned embryos of Marco Polo argali. He implanted embryos in his ewes and in May 2017 bred a male argali, who he named Montana Mountain King.

"In the following years, Schubarth bred Montana Mountain King’s semen with other ewe species, creating more hybrid sheep that he sold to captive hunting facilities, mainly in Texas. To do so, he bought Rocky Mountain bighorn sheeps’ testicles, despite Montana prohibiting trade of game animals."

The NAS proposes that bans on studying marijuana and its effects should be relaxed

 The National Academy of Sciences has just issued a new report on marijuana and public health.  Among their recommendations is that bans on research should be rescinded. (Because marijuana is currently a Schedule I drug in the Controlled Substances Act, it's hard to get permission to study it and its effects...)

Cannabis Policy Impacts Public Health and Health Equity (2024)

Nondirected liver donation in Canada--from the beginning

The Ottawa Citizen has the story:

The Gosling Effect: How one man (and his liver) forever changed Canadian health care. In 2005, Kevin Gosling became the first living Canadian to anonymously donate an organ to a stranger. It set a cascade of kindness into motion.  by Elizabeth Payne 

"It had been a long road for the then-46-year-old from Cornwall, Ont. For months, health officials wouldn’t take him seriously when he offered to donate the organ anonymously. We don’t do that here, he was told. Not only that, it had never been done before anywhere in Canada.

"Some top officials in Canada’s leading liver transplant program were adamantly opposed to Gosling’s proposal. They said it was unethical and immoral. They questioned his motives, even his sanity. But Gosling persisted, so far as to undergo months of physical and psychological testing and preparation.

"After more than a year and a half, everything was set to go.

...

"Gosling didn’t know much about the recipient. He only knew that it was a child.

...

"Gosling’s stubborn altruism and unwavering belief that he could make a life-changing difference to someone in desperate need almost single-handedly changed Canada’s health-care system.

"In the 19 years since that fateful day when transplant surgeons removed part of Gosling’s liver and transplanted it into the body of the very ill child, the Toronto General Hospital has completed more than 137 such operations involving people donating anonymously to strangers – more than any other hospital in the world.

...

"He was a pioneer in an area in which Canada is now a world leader – the act of anonymously donating part of a liver – a phenomenon that continues to be met with disbelief in some parts of the world.

...

"Gosling’s offer was turned down multiple times until he was eventually put in touch with the head of the multi-organ transplant program at University Health Network, one of only two hospitals in the country where living liver transplants are now routinely done. Along the way he met health officials who were adamantly opposed to the idea, even citing the Hippocratic oath. (Later, he was told by one staunch opponent that following Gosling’s case had made him change his mind.)"

HT: Colin Rowat

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See also:

Cattral, Mark S., Anand Ghanekar, and Nazia Selzner. "Anonymous living donor liver transplantation: The altruistic strangers." Gastroenterology 165, no. 6 (2023): 1315-1317.

and here are all my posts on nondirected donors: https://marketdesigner.blogspot.com/search/label/nondirected%20donor

California Bans Legacy Admissions at Private Universities.

 The NYT has the story:

California Bans Legacy Admissions at Private Universities. The change will affect Stanford University, the University of Southern California and other private colleges in the state. By Shawn Hubler and Soumya Karlamangla, Sept. 30, 2024

"California will ban private colleges and universities, including some of the nation’s most selective institutions, from giving special consideration to applicants who have family or other connections to the schools, a practice known as legacy admissions.

"Gov. Gavin Newsom signed legislation on Monday that will prohibit the practice starting in the fall of 2025.

...

"The University of California, the California State University System and other public California campuses have banned legacy admissions for decades. But private colleges continued to give some preference to the descendants of alumni or major donors.

...

"Only one other state, Maryland, bans legacy preferences at both private and public institutions. Illinois, Virginia and Colorado ban legacy admissions, but only at public universities and colleges.
...

"After the Varsity Blues scandal in 2019, in which parents seeking to win spots in top-ranked schools for their children were found to have paid bribes and falsified their children’s credentials, Mr. Ting tried to push through a bill banning legacy preferences in California. That effort fell short.

"But he did succeed with a measure requiring private colleges to report to the Legislature how many students they admit because of ties to alumni or donors. Those reports showed that the practice was most widespread at Stanford and U.S.C., where, at both schools, about 14 percent of students who were admitted in the fall of 2022 had legacy or donor connections. At Santa Clara University, Mr. Newsom’s alma mater, 13 percent of admissions had such ties.

"Republicans as well as Democrats in the California Legislature voted for Mr. Ting’s latest proposal, which will punish institutions that flout the law by publishing their names on a California Department of Justice website. An earlier version had proposed that schools face civil penalties for violating the law, but that provision was removed in the State Senate."

Should fox hunters be a protected minority?

 The NYT reports on the question:

Fox Hunters in the U.K. Want Protected Status Under Discrimination Law. A lobbying group is preparing a bid to define hunting with animals as a protected belief. Many experts have questions.  By Amelia Nierenberg

"English fox hunters have tried, for years, to push back against a nearly 20-year-old ban on their beloved sport.

"The centuries-old tradition of using packs of dogs to chase and kill foxes — or any wild mammals — became illegal in England in 2005, after a long parliamentary struggle driven by campaigners and lawmakers who opposed it on animal welfare grounds.

"So far, the law has stood, and fox hunting remains hugely unpopular among the general public: 80 percent of people in Britain think it should remain illegal, according to YouGov, a polling company.

"Now, a pro-hunting activist has a new plan of attack.

"Ed Swales, the activist, founded Hunting Kind, a lobby group that aims to protect hunting with dogs and other forms of hunting, in early 2022. He wants to use Britain’s Equality Act — which protects people from discrimination because of their age, race, sexuality or religion, among other things — to classify a pro-hunting stance as a protected belief.

...

“We’ve been doing this for millennia,” he said. Hunting is “literally part of our cultural heritage.”

"Hunting itself is not illegal in England. Shooting deer, rabbits, duck and some other animals is allowed during hunting seasons, with permission from the landowner and a gun license.

...

"Last year, Chief Superintendent Matt Longman, England’s police lead on fox hunting, said that illegal hunting was “still common practice,” with trail hunts frequently taking place in natural fox habitats.

...

"In 2007, a belief in fox hunting was explicitly denied protection in Scotland’s courts, where a judge found that “a person’s belief in his right to engage in an activity which he carries on for pleasure or recreation, however fervent or passionate,” did not compare to protected beliefs or religion, and therefore would not be covered under human rights law.

"And in 2009, the European Court of Human Rights unanimously ruled that the ban on fox hunting with dogs did not violate human rights."