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Dialysis Discussion => Dialysis: News Articles => Topic started by: xtrememoosetrax on January 31, 2008, 05:42:29 AM
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New York Times
January 31, 2008
Economists Dissect the ‘Yuck’ Factor
By PATRICIA COHEN
WASHINGTON — You can kill a horse to make pet food in California, but not to feed a person. You can hoist a woman over your shoulder while running a 253-meter obstacle course in the Wife-Carrying World Championship in Finland, but you can’t hold a dwarf-tossing contest in France. You can donate a kidney to prevent a death and be hailed as a hero, but if you take any money for your life-saving offer in the United States, you’ll be jailed.
These prohibitions are not imposed because of concerns about health or safety or unfair practices, some economists say, but because people tend to find such activities repugnant. In other words, just hearing about them can cause a queasy sensation in the pit of your stomach.
People don’t pay enough attention to how repugnance affects decisions about what can be bought and sold, asserts Alvin Roth, an economist at Harvard University.
Mr. Roth spoke at a recent panel on the economics of repugnance at the American Enterprise Institute, a conservative research organization in Washington. For conservatives the issue can be particularly pointed. Economic conservatives tend to favor eliminating as many hindrances on the market as possible, while social conservatives believe some practices are so “repugnant” — because they violate traditional values or religious and moral prohibitions — that they should be banned from the marketplace altogether.
Of course the dividing line between mercenary, soulless capitalists and defenders of human dignity is not always clear. As Mr. Roth pointed out, ideas about what is repugnant change all the time. Selling oneself into indentured servitude was once thought permissible, while charging interest on loans was not.
In recent years groups have fought over whether it is acceptable to display and sell art that offends religious sensibilities, like a photograph of a crucifix in urine or a sculpture of Jesus on the cross, made out of chocolate. “Bodies ... The Exhibition” and similar shows, which feature the preserved and dissected remains of people, would once have been considered both ghoulish and profane. Although religious leaders, human-rights activists and medical officials have condemned the cadaver exhibitions, the displays have attracted millions of visitors in the United States and around the world.
And last week a woman in Ohio whose ad to sell a horse mistakenly appeared under the heading “Good Things to Eat” in a newspaper’s classified section received dozens of calls, some expressing outrage and others from people interested in turning it into dinner. (In Europe and Japan horse meat on a menu would stir no more comment than macaroni and cheese would in an American diner.)
Arthur C. Brooks, a professor of government and business at Syracuse University who moderated the Washington panel, spoke of how he — like thousands of other Americans — carried $7,000 in hundred dollar bills to ease the adoption of an abandoned baby in China despite a visceral reaction against the idea of buying and selling children.
“It’s very hard to predict what’s repugnant and what’s not,” Mr. Roth said. Paul Bloom, a professor of psychology at Yale, agreed. He conducted a two-year study to try to get at why people consider athletes who take steroids to be cheating, but not those who take vitamins or use personal trainers. He and his team offered different possibilities: What if steroids were completely natural? Or were not at all harmful? Or were only effective if the athlete had to work harder than before?
The only change that caused the interviewed subjects to alter their objections to steroids was when they were told that everyone else thought it was all right. “People have moral intuitions,” Mr. Bloom said. When it comes to accepting or changing the status quo in these situations, he said, they tended to “defer to experts or the community.”
Often introducing money into the exchange — putting it into the marketplace — is what people find repugnant. Mr. Bloom asserted that money is a relatively new invention in human existence and therefore “unnatural.”
Economists are asking the wrong question, Mr. Bloom said at the panel. They assume that “everything is subject to market pricing unless proven otherwise.”
“The problem is not that economists are unreasonable people, it’s that they’re evil people,” he said. “They work in a different moral universe. The burden of proof is on someone who wants to include” a transaction in the marketplace. (Mr. Roth, who acknowledges that “economists see very few tradeoffs as completely taboo,” did not take the criticism personally.)
The theologian Michael Novak, who is also a resident scholar at the American Enterprise Institute, similarly argued that “not all ethical principles fit under economic reasoning,” adding, “the resistance to money is very old and very deep.”
Money is clearly the issue in situations involving the human body. Paying young women for eggs to be fertilized and men for sperm is now common practice — even though they are still regularly referred to as “donors.” Yet the sale of tissue, cells and eggs for stem-cell research or organs for transplant are still the subject of vehement dispute.
Pope John Paul II said that treating human organs as part of any commercial exchange is “morally unacceptable,” a view echoed by the Council of Europe’s Convention on Human Rights and Biomedicine.
In the United States federal law prohibits the sale or purchase of human organs. The American Kidney Foundation itself opposes payments on the ground that it “devalues life.” And the conservative bioethicist Leon Kass, who was chairman of the President’s Council on Bioethics from 2002 to 2005, has called the commercialization of body parts “just inherently wrong.”
“If we come to think about ourselves like pork bellies, pork bellies we will become,” Mr. Kass has written.
Sally Satel, a psychiatrist and resident scholar at the institute who was herself the recipient of a kidney donation in 2006, asserts that the issue does not need to pit human dignity against saving a life. “A salaried fireman who saves a life is not less heroic,” she said. “An object or act can have a price and still be invaluable.”
She has forcefully argued in The New York Times Magazine and elsewhere that the sale of human organs with proper oversight to prevent exploitation of the poor should be permitted. There are 74,000 people on the waiting list, and in 2006 about 4,400 died before they could get a kidney. The need is too great, she said. The Nobel Prize-winning economist Gary Becker and his colleague Julio Jorge Elias have even calculated how much a kidney should sell for to eliminate the backlog completely.
In recent years Mr. Roth has helped set up “paired kidney donations,” in effect, allowing sets of donors and patients to swap kidneys in order to find a compatible one. These kidney exchanges, which started in 2005, have gained growing acceptance nationwide, he said.
To Mr. Novak instinctual human revulsion is an important attribute. Quoting Aristotle, he said “repugnance makes a necessary contribution to the good life, especially when there is not time for intellectual evaluation.” A number of psychologists, philosophers and biologists (most recently Stephen Pinker, also in The Times Magazine) have similarly argued that repugnance is morality’s early warning system, an alarm bell that warns that a subject deserves moral scrutiny.
Still, such intuitions are “not always the best director,” Mr. Novak said. As in the case of kidney transplants, one must choose “between two great moral ends,” he said.
That is why, he added, “mere repugnance is not enough.”
http://www.nytimes.com/2008/01/31/arts/31gross.html