Burning Kidneys
Can we do better than donations?
Everyone should go read Scott Alexander’s remarkable post about donating his kidney (if you haven’t already). One question he raises is why so many effective altruists donate a kidney, given that it “has an unusually high ratio of photogenic suffering to altruistic gains.” (Most of us would find it a lot easier to instead make a kidney-equivalent donation of $$ to good causes.) But, as he notes towards the end of the post:
Coalition To Modify NOTA [to provide tax incentives to encourage more widespread kidney donation] is full of previous living kidney donors, who are using the moral clout and recognition they’ve gotten to get attention and change the system in an unglamorous way. I find this an admirable way of squaring the circle: do the flashy heroic things to gain social capital, then spend the social capital on whatever’s ultimately most important.
A decade ago, Alexander Berger got a NY Times op-ed selling the idea of selling kidneys out of his own altruistic donation. So that was awesome. But it is striking that most the expected benefit here turns out to be indirect: more from the publicity for a good policy proposal than the good done for the immediate kidney recipient (though the latter is certainly also good!).
This got me thinking. Suppose someone was prepared to donate a kidney, but then at the last minute, instead of letting it go to the recipient, they insisted on burning it.
Seems messed up! But now imagine that the would-be donor has a story to tell. Their act of horrendous, gratuitous wastefulness was an act of protest to draw attention to the gratuitous wastefulness of our current policy situation. After all, they point out, having the government pay for kidneys would:
(1) Save taxpayers money, compared to what the government pays for dialysis.
(2) Greatly benefit dialysis patients, who desperately need more kidneys to be made available for transplantation. And also:
(3) Benefit the new donors, who are keen to go through a medical process that’s comparable in risk to childbirth if sufficiently well compensated.
Our current policy harms all three groups, by comparison, for no good reason. It’s the moral equivalent of burning kidneys by the bus load. However horrified you are by this lone individual gratuitously burning their kidney when it could have saved someone, you should be all the more horrified by government policies that gratuitously deprive thousands of the kidneys that they need.
"However horrified you are by this lone individual gratuitously burning their kidney when it could have saved someone, you should be all the more horrified by government policies that gratuitously deprive thousands of the kidneys that they need."
Well, the government's intervention is in some sense more causally *distal* to the sick person eventually not getting the kidney than would be the burning-action. Thus by (I conjecture) widely-held principles of penalizing harm in-proportion-to some notion of its causal proximity, it's not as bad.
I would expect deontologists to be furiously working on trying to elaborate such accounts. Somehow I don't observe them doing that.
Right now, my brain is primarily hurting at the thought of deontologically-minded masses who regard "selling" kidneys as the blackest of evils, supporting the exact goddamned same thing via government, but using different magic words like "tax credit" and "incentive". Except, of course, that instead of an actual market price, we'll end up with bureaucrats who have a stake in never seeing the funding for the program decrease, leading to price floors and *extra* kidneys being paid for and thrown in the trash.