David R. Henderson  

The Slippery Slope Not Taken

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Two slippery slopes diverged in a wood, and I--
I took the one less traveled by,
And that has made all the difference.
--David R. Henderson, with apologies to Robert Frost

Like my co-blogger Scott Sumner, I hope that certain steps to make it legal for organ donors to accept compensation lead to "a full fledged commercial market for organs." I have written about that here and here.

But I do worry about which slippery slope we will go down. Scott approvingly quotes Sally Satel of the American Enterprise Institute:

[To] save lives, let's test incentives. A model reimbursement plan would look like this: Donors would not receive a lump sum of cash; instead, a governmental entity or a designated charity would offer them in-kind rewards, such as a contribution to the donor's retirement fund; an income tax credit or a tuition voucher; lifetime health insurance; a contribution to a charity of the donor's choice; or loan forgiveness.

Here's the problem. Many of those measures involved government subsidies or tax credits, and the latter are essentially the former.

What's wrong with that? Government subsidies requires that the government forcibly take money from some strangers to give to other strangers. If someone proposed a bill to give government subsidies to people who donate organs, I would be tempted to oppose it. That could be a very bad slippery slope.

All we advocates of voluntary exchange are saying is give voluntary exchange a chance.


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COMMENTS (13 to date)
Rick Hull writes:

Regarding this topic and the earlier one about legalizing prostitution, I expected to see the (very compelling) argument that if act A is morally permissible, it remains so even when performed for money (or exchange).

So if voluntary sexual intercourse is morally permissible, it remains so even if one party is compensated. Likewise for organ donation.

David R. Henderson writes:

@Rick Hull,
Good argument.

Toby writes:

Why would an act remain morally permissible if money is paid for it in exchange?

Act A is morally permissible. Therefore, if Act A is combined with Act B it remains morally permissible.

I don't see how this follows without also assuming something about Act B or what happens if Act B is joined with Act A.

How about the following counter-example. Two fifteen year old are having voluntary sexual intercourse. This doesn't seem to be immoral.

Now one fifteen year old pays another fifteen year old to have sex with. This seems to be somewhat immoral or not?

Now let's say that you do find that to be morally permissible. What's morally impermissible about a fifty year old paying a fifteen year old to have sex?

John Goodman writes:

I believe we have found a solution to this problem in the market for babies.

The adopting parents reimburse the birth mothers for their medical and other expenses and these "other expenses" turn out to be quite large.

In fact "other expenses" tend to equal the free market price of new born babies.

Surprise.

David R. Henderson writes:

@John Goodman,
Excellent idea.

Rick Hull writes:

Toby,

If Act A (voluntary sexual intercourse between consenting adults) is morally permissible, and Act B (one person paying another) is morally permissible, then surely the conjunction remains so.

From your examples, if 15-15 sex is morally permissible, then payment matters naught. Likewise for 15-50 sex. I'm guessing you find 15-50 sex repugnant, regardless of payment.

Toby writes:

Rick, I don't think that follows logically.

If a little bit of poison A does not kill you and a little bit of poison B does not kill you then it does not follow that a little bit of poison A and poison B will not kill you. You need to make an additional assumption for the conclusion to follow. For example little bit of poison A + little bit of poison B is smaller than your tolerance to poison (assuming that these can be added up.).

In addition, it does not necessarily follow that even if Act A and Act B together are morally permissible that every instance where you observe Act A and Act B you are observing something that is morally permissible.

Take again the poison example but now assuming that you've ingested a little bit of poison C and that your tolerance to poison is smaller than poison C + poison B + poison A.

As for the prostitution examples, I would find two fifteen year olds / children exchanging money for sex repugnant. Mostly, I suppose because I worry about the presence of consent. I believe that they believe that they consented, but I don't think they could reasonably be aware of the full extent of their actions. I think that the ability to consent for payment is absent whereas the ability to consent for merely sex can be said to be present in two horny teenagers. So yes I do believe that money can change things.

For organ transplants I tend to view this practically. Voluntary exchange in kind such as matching is unproblematic. Exchange with money involved is more likely to be problematic.

In a perfect world, then yes there is no issue. In an imperfect world with fallible human actors it can be problematic to assume that because in one type of exchange there is consent that there will be consent in a similar type of transaction.

To conclude, I don't find the argument made to be logically sound stated as it is, and even if it would be then I seriously doubt its relevance for practice. It is trivially true that there is consent if there is consent, but that is precisely the problem: we don't know whether and how often there is consent.

Toby writes:

Rick, I don't think that follows logically.

If a little bit of poison A does not kill you and a little bit of poison B does not kill you then it does not follow that a little bit of poison A and poison B will not kill you. You need to make an additional assumption for the conclusion to follow. For example little bit of poison A + little bit of poison B is smaller than your tolerance to poison (assuming that these can be added up.).

In addition, it does not necessarily follow that even if Act A and Act B together are morally permissible that every instance where you observe Act A and Act B you are observing something that is morally permissible.

Take again the poison example but now assuming that you've ingested a little bit of poison C and that your tolerance to poison is smaller than poison C + poison B + poison A.

As for the prostitution examples, I would find two fifteen year olds / children exchanging money for sex repugnant. Mostly, I suppose because I worry about the presence of consent. I believe that they believe that they consented, but I don't think they could reasonably be aware of the full extent of their actions. I think that the ability to consent for payment is absent whereas the ability to consent for merely sex can be said to be present in two horny teenagers. So yes I do believe that money can change things.

For organ transplants I tend to view this practically. Voluntary exchange in kind such as matching is unproblematic. Exchange with money involved is more likely to be problematic.

In a perfect world, then yes there is no issue. In an imperfect world with fallible human actors it can be problematic to assume that because in one type of exchange there is consent that there will be consent in a similar type of transaction.

To conclude, I don't find the argument made to be logically sound stated as it is, and even if it would be then I seriously doubt its relevance for practice. It is trivially true that there is consent if there is consent, but that is precisely the problem: we don't know whether and how often there is consent.

Rick Hull writes:

Briefly, I'll grant your poison example, but moral permission does not operate like poison tolerance. I don't understand your response on prostitution and afterward. In my example, consent is a given. If there is any nonconsensual aspect to Act A, then I believe your objection lies with Act A.

Rick Hull writes:

Upon reflection, I think your objection is that payment can act like a lure to get people to do things they otherwise wouldn't. Like a molester van full of candy. Or offering someone $1M to donate their legs. Or tattoo themselves with corporate logos.

I suppose this is thornier, but it's also a description of employment. Also, because consent is a premise, we should not be considering children or anyone for whom consent is inherently questionable.

John Thacker writes:

In the case of kidney transplants, I would recognize that currently federal law pays for nearly all dialysis under the End Stage Renal Disease Program, regardless of age or condition. It's an extremely expensive program that is questioned by many experts (not just economists) though of course it has defenders and paid for by a great amount of tax money.

So in that sense, we are already at the end of a slippery slope. Indeed, one argument I have commonly heard for tax credits or other government compensation for kidney donors is a claim that it would actually save tax money, since there is a shortage of kidneys and dialysis is so tremendously expensive for the government.

John Thacker writes:

Also consider that charitable deductions in the tax code for intangible property given from one person to another are also a well-established principle, and organ donation tax credits would be similar along those lines. I recognize that "tax credits... are essentially [government subsidies]" which are paid out of tax revenue from one point of view (hence the argument about tax expenditures), but I feel that the charitable deduction is not the worst of them, and it would be a much smaller drop along a slippery slope, if any, to expand the charitable deduction in this way by valuing organs.

Toby writes:

Rick, I agree that morality does not work like poison does. It is merely to illustrate that as a matter of logic the conclusion does not follow from the premises. If money can change matters, then it is not sufficient to note that in the absence of money consent is assumed to be present. The interesting bit is consent and that as you note can be a thorny issue. I would, however, extend this to adults as well.

The reason that I would extend this to adults here as well is that a gift is done for very different reasons than a sale. Consent is far more likely to be present in the former than in the latter and regret seems less likely. A sale extends the parties with whom you could interact to strangers. Of course I can think of situations where consent between family members and friends is problematic. I just don't think that that is the case here. I might be wrong though. The presence of consent is, after all, an empirical assumption and this is not something that can be deduced apriori or assumed to exist due to the similarity to another situation.

Having said this, I would like to see a market for organs. If consent can be guaranteed to a reasonable degree. That is the safeguards ought to be proportional to the potential impact. These would have to be stronger than for an employment relation and stronger than for when an organ is donated.

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