R1 NEG V.NORTHWESTERN MV 2NR AT: MATAS Matas oversimplifies Leichtman 2006 – University of Michigan Division of Nephrology (Alan and Gabriel Danovitch, David Geffen School of Medicine at UCLA, Clinical Journal of the American Society of Nephrology, “Kidney vending: the ‘Trojan horse’ of organ transplantation”, Clin J Am Soc Nephrol 2006; 1:1133) As physicians and nephrologists who are actively engaged in the evaluation and the treatment of kidney transplant candidates, recipients, and donors, we are concerned by what we see as a growing threat to the core values that have permitted organ transplantation to flourish during the last half century. Kidney vending, once considered taboo in “respectable” circles, is being debated with some frequency, and in this issue of JASN, specific proposals for implementation have been made. To his credit, Matas (1) presents his case in a rational and dispassionate manner. In the professional and lay press, however, there has been a disturbing change of tone. Those who oppose vending have been derided as “beancounters” and “high-minded moralists” (2); the current system has been described as a “failure” (3); routine psychological evaluation of donors has been described as “intrusive, demeaning” (4); the Institute of Medicine’s caution against treating the body as if it were for sale (5) has been described as “outdated thinking” (6); and respected transplant professionals have been castigated in the national press because of their concern for the potential exploitation of donors (7). There is a lot at stake. The altruistic impulses of living donors and of the families of deceased donors are on the auction block and risk being displaced by the uncertainties of an unfamiliar market place. Matas seems unconcerned by this possibility, and to some proponents of organ vending, the anticipated demise of altruism in organ donation even comes as a blessing (2). To the detractors of our current altruism-based system, the acceptance by the general public of the difficult concepts (brain death, donation after cardiac death, living donation, etc.) that are at the core of our work is taken for granted, because the supply of donors has been inadequate for the need. Dollars will solve our problem: Put kidneys up for sale (valued at approximately $90,000 by Matas’s estimate [8]) and there will be enough organs for everyone. Imagine: No more waiting lists. And it all will be “above board” and run by regional organ procurement organizations and professional panels that will vet donors, protect their health, allocate the kidneys, and administer the finances (1)—all done in a manner that is beyond reproach. We are skeptical. 1NC 1NC POLITICS Iran’s top priority but Obama’s PC holds off override now Everett, 1/21/15 (Burgess, “Democratic Iran hawks hesitate on overriding Obama; Obama’s overtures to Senate Democrats complicate matters for Republicans working on sanctions bills,” http://www.politico.com/story/2015/01/iran-senate-democrats-barack-obama-114467.html?hp=r1_4, JMP) Republicans are eager to rumble with the White House over sanctions on Iran, but they may have trouble getting President Barack Obama’s Democratic critics to go along. A day after Obama vowed to veto any bill that could jeopardize nuclear talks with Tehran, Republicans were working on two pieces of legislation that could move in conjunction with Israeli Prime Minister Benjamin Netanyahu’s address to Congress on Feb. 11. But it quickly became clear that Republicans have a problem: Senate Democrats who might not like Obama’s policies on Iran but may not be ready to override their president, especially after the forceful arguments he made in the State of the Union. In interviews Wednesday, several Democrats who had supported a previous version of Iran legislation sponsored by Sen. Mark Kirk (R-Ill.) said they are reconsidering their positions. Meanwhile, a previous version of an Iran bill offered by Sen. Bob Corker (R-Tenn.) did not have any Democratic cosponsors. Last week, at the Senate Democratic retreat in Baltimore, Obama forcefully made a case against further Iran legislation. He did the same thing Tuesday night in front of millions of Americans, saying he would veto any sanctions legislation because it would “all but guarantee that diplomacy fails.” Obama’s words appear to be sinking in. said Sen. Richard Blumenthal (D-Conn.). “I’m talking to colleagues on both sides of the aisle. And I think they are thinking, and rethinking, their positions in light of the points that the president and his team are making to us.” Asked if he’s spoken directly to Obama about Iran, Blumenthal said: “The president and his staff are in touch with all of us.” “I’m considering very seriously the very cogent points that he’s made in favor of delaying any congressional action,” Sen. Mark Warner (D-Va.) said he is actively weighing the president’s position against Warner’s own belief that Congress needs to keep pressure on Iran. Even the hawkish Sen. Robert Menendez (D-N.J.), who said Wednesday that the administration’s comments sound “like talking points straight from Tehran,” was noncommittal on whether he would again co-sponsor Iranian sanctions legislation that he once led. “I have no idea yet,” Menendez said. The issue, said Sen. Chuck Schumer of New York, is one of timing. While Democrats and Republicans alike want to be tough on Iran, the president’s party is more open to giving Obama some breathing room. “There’s overwhelming support to toughen up the sanctions,” said Schumer, a member of Democratic leadership who co-sponsored sanctions legislation last year. “The question is when. At times in the past the president asked for a little time, until March. That’s something people are looking at.” Kirk’s bill would impose new sanctions if diplomatic talks fall apart or Iran violates an interim deal. Corker’s would allow Congress an up-or-down vote to reject or approve any final deal between the U.S. and its allies and Iran. Sources familiar with the process in both chambers said Republicans have made no final decision on which bill will provide the base for the legislation. Another option is merging versions of the two bills, though Corker doubted that would happen. The House is also working on new sanctions legislation. A decision is expected in the near future, with a vote perhaps as early as February, given the support Iran legislation enjoys from Senate Majority Leader Mitch McConnell (R-Ky.) and House Speaker John Boehner (R-Ohio). On the GOP bill to approve the Keystone XL oil pipeline, Obama swiftly came out with a veto threat because it was clear not enough Democrats in Congress would vote to override him. That’s not the case for Iran: Sixty senators publicly supported sanctions legislation in the last Congress, but it was widely believed that more Democrats would have voted for the bill if it had come to the floor. Senate Minority Whip Dick Durbin (D-Ill.) said the vote would be a nail-biter if it were held today. But he expects enough Democrats to have Obama’s back to reject an override, whether on tightening sanctions or requiring congressional approval for a nuclear deal. “If I had to be pushed, I’d guess there’s at least 34 that would say: ‘This is premature, we should wait,’” Durbin said in an interview. “If there’s anything that we would do that would jeopardize the negotiations, I think many Democrats would oppose it.” Republicans think Democrats are bluffing and will be unable to oppose hardline legislation on Iran, whatever form it takes. But they acknowledge that it’s a tricky calculus to get to 67 votes when the president is leaning so hard on Democrats to hold the line, which might require legislation quite different from what’s been proposed so far. “At some point, we’re going to get to the magic 67 and be able to override this veto,” said Senate Majority Whip John Cornyn (RTexas). “We’re in the process of figuring out what that would look like to command the broadest possible support in the Senate. And then we’ll have that debate with the president.” Of course, the GOP may have further problems getting to 67 thanks to defections from Sens. Rand Paul (R-Ky.) and Jeff Flake (R-Ariz.), who have stayed away from new sanctions legislation. “While negotiations are going on, I worry that we will fracture our coalition,” Flake said of Western nations that have coordinated on Iran negotiations and sanctions. “I want to keep that coalition together.” Secretary of State John Kerry aims to have a framework for a deal by March, so the race is on in the Senate to beat him to the punch. The Banking Committee postponed its vote on the Kirk bill this week but will move swiftly next week with a hearing Tuesday, a classified briefing from the administration on Jan. 28 and a committee vote Jan. 29, Chairman Richard Shelby (R-Ala.) said. Corker is also ramping up activity — he held a hearing on Iran on Wednesday and is moving toward developing a new draft bill. Massive backlash to organ sales and the link alone turns case Caplan, 7 – NYU bioethics division head and professor [Arthur, Ph.D. in the history and philosophy of science from Columbia, Drs. William F and Virginia Connolly Mitty Professor and head of the Division of Bioethics at New York University Langone Medical Center in New York City, "Do No Harm: The Case Against Oran Sales from Living Persons," Living Donor Transplantation, ed by Henkie Tan, p432-434, google books, accessed 8-27-14] What little data exist show that health-care providers are opposed to markets (19). If they are not willing to support markets out of moral reservations, then markets simply will not be effectively implemented. Even more important than a patent lack of enthusiasm for markets among those who would be expected to serve them, major religions and cultural views in the developed world will not countenance a market in living body parts (20-22), Various Popes, for example, have made quite clear the Catholic Church's aversion to markets in organs. Anglo-American law, ever since the days in which markets in body parts resulted in graveyards being stripped to supply medical schools with teaching materials, has not recognized any property interest in the human body and its organs (22). Alienating religions and cultures which do not view the body as property would have a devastating impact on the supply of organs available. Indeed, some sub-populations in the United States, particularly African Americans, are as likely to be turned off by the institution of a market in body parts because of their historical experiences with slavery and a keen distrust of medicine, as they are to be motivated to become sellers to the rich (23-26). The argument that increasing the supply of organs through sales will be efficient and cost- effective is not persuasive. It will take real and expensive resources to try to regulate and police a market in organs. Since markets, even regulated ones, would shift the supply of organs toward those who can afford to buy them, those who cannot might well withdraw from participation in the deceased-donor organ system, thereby putting in peril any overall increase in the pool of organs available to transplant. The case for kidney sales is not persuasive. Existing experience with markets has been dismal. The notion that free choice supports the creation of markets in human body parts does not square with the reality of what leads people to be likely to want to sell them. The devastating moral cost to medicine of engaging in organ-brokering is far too great a price to pay for the meager benefit in supply that might be had by those in need of transplants. The storm of opposition that markets will trigger in many individuals based on religious or cultural objections may actually produce a decrease rather than an increase in the overall pool of transplantable organs- an outcome that by itself would make calls for the creation of markets dubious. That directly trades-off with the political capital necessary to prevent a veto override on Iran sanctions. Failure will spur prolif and war with Iran. Beauchamp, 11/6/14 --- B.A.s in Philosophy and Political Science from Brown University and an M.Sc in International Relations from the London School of Economics, former editor of TP Ideas and a reporter for ThinkProgress.org. He previously contributed to Andrew Sullivan’s The Dish at Newsweek/Daily Beast, and has also written for Foreign Policy and Tablet magazines, now writes for Vox (Zack, “How the new GOP majority could destroy Obama's nuclear deal with Iran,” http://www.vox.com/2014/11/6/7164283/iran-nuclear-deal-congress, JMP) There is one foreign policy issue on which the GOP's takeover of the Senate could have huge ramifications, and beyond just the US: Republicans are likely to try to torpedo President Obama's ongoing efforts to reach a nuclear deal with Iran. And they just might pull it off. November 24 is the latest deadline for a final agreement between the United States and Iran over the latter's nuclear program. That'll likely be extended, but it's a reminder that the negotiations could soon come to a head. Throughout his presidency, Obama has prioritized these negotiations; he likely doesn't want to leave office without having made a deal. But if Congress doesn't like the deal, or just wants to see Obama lose, it has the power to torpedo it by imposing new sanctions on Iran. Previously, Senate Majority Leader Harry Reid used procedural powers to stop this from happening and save the nuclear talks. But Senate Majority Leader Mitch McConnell may not be so kind, and he may have the votes to destroy an Iran deal. If he tries, we could see one of the most important legislative fights of Obama's presidency. Why Congress can bully Obama on Iran sanctions At their most basic level, the international negotiations over Iran's nuclear program (they include several other nations, but the US is the biggest player) are a tit-for-tat deal. If Iran agrees to place a series of verifiable limits on its nuclear development, then the United States and the world will relax their painful economic and diplomatic sanctions on Tehran. "The regime of economic sanctions against Iran is arguably the most complex the United States and the international community have ever imposed on a rogue state," the Congressional Research Service's Dianne Rennack writes. To underscore the point, Rennack's four-page report is accompanied by a list of every US sanction on Iran that goes on for 23 full pages. The US's sanctions are a joint Congressional-executive production. Congress puts strict limits on Iran's ability to export oil and do business with American companies, but it gives the president the power to waive sanctions if he thinks it's in the American national interest. "In the collection of laws that are the statutory basis for the U.S. economic sanctions regime on Iran," Rennack writes, "the President retains, in varying degrees, the authority to tighten and relax restrictions." The key point here is that Congress gave Obama that power — which means they can take it back. "You could see a bill in place that makes it harder for the administration to suspend sanctions," Ken Sofer, the Associate Director for National Security and International Policy at the Center for American Progress (where I worked for a little under two years, though not with Sofer directly), says. "You could also see a bill that says the president can't agree to a deal unless it includes the following things or [a bill] forcing a congressional vote on any deal." Imposing new sanctions on Iran wouldn't just stifle Obama's ability to remove existing sanctions, it would undermine Obama's authority to negotiate with Iran at all, sending the message to Tehran that Obama is not worth dealing with because he can't control his own foreign policy. So if Obama wants to make a deal with Iran, he needs Congress to play ball. But it's not clear that Mitch McConnell's Senate wants to. Congress could easily use its authority to kill an Iran deal To understand why the new Senate is such a big deal for congressional action on sanctions, we have to jump back a year. In November 2013, the Obama administration struck an interim deal with Iran called the Joint Plan of Action (JPOA). As part of the JPOA, the US agreed to limited, temporary sanctions relief in exchange for Iran limiting nuclear program components like uranium production. Congressional Republicans, by and large, hate the JPOA deal. Arguing that the deal didn't place sufficiently serious limits on Iran's nuclear growth, the House passed new sanctions on Iran in December. (There is also a line of argument, though often less explicit, that the Iranian government cannot be trusted with any deal at all, and that US policy should focus on coercing Iran into submission or unseating the Iranian government entirely.) Senate Republicans, joined by more hawkish Democrats, had the votes to pass a similar bill. But in February, Senate Majority leader Harry Reid killed new Iran sanctions, using the Majority Leader's power to block consideration of the sanctions legislation to prevent a vote. McConnell blasted Reid's move. "There is no excuse for muzzling the Congress on an issue of this importance to our own national security," he said. So now that McConnell holds the majority leader's gavel, it will remove that procedural roadblock that stood between Obama and new Iran sanctions. To be clear, it's far from guaranteed that Obama will be able to reach a deal with Iran at all; negotiations could fall apart long before they reach the point of congressional involvement. But if he does reach a deal, and Congress doesn't like the terms, then they'll be able to kill it by passing new sanctions legislation, or preventing Obama from temporarily waiving the ones on the books. And make no mistake — imposing new sanctions or limiting Obama's authority to waive the current ones would kill any deal. If Iran can't expect Obama to follow through on his promises to relax sanctions, it has zero incentive to limit its nuclear program. "If Congress adopts sanctions," Iranian Foreign Minister Javad Zarif told Time last December, "the entire deal is dead." Moreover, it could fracture the international movement to sanction Iran. The United States is far from Iran's biggest trading partner, so it depends on international cooperation in order to ensure the sanctions bite. If it looks like the US won't abide by the terms of a deal, the broad-based international sanctions regime could collapse. Europe, particularly, might decide that going along with the sanctions is no longer worthwhile. "Our ability to coerce Iran is largely based on whether or not the international community thinks that we are the ones that are being constructive and [Iranians] are the ones that being obstructive," Sofer says. "If they don't believe that, then the international sanctions regime falls apart." This could be one of the biggest fights of Obama's last term It's true that Obama could veto any Congressional efforts to blow up an Iran deal with sanctions. But a two-thirds vote could override any veto — and, according to Sofer, an override is entirely within the realm of possibility. "There are plenty of Democrats that will probably side with Republicans if they try to push a harder line on Iran," Sofer says. For a variety of reasons, including deep skepticism of Iran's intentions and strong Democratic support for Israel, whose government opposes the negotiations, Congressional Democrats are not as open to making a deal with Iran as Obama is. Many will likely defect to the GOP side out of principle. The real fight, Sofer says, will be among the Democrats — those who are willing to take the administration's side in theory, but don't necessarily think a deal with Iran is legislative priority number one, and maybe don't want to open themselves up to the political risk. These Democrats "can make it harder: you can filibuster, if you're Obama you can veto — you can make it impossible for a full bill to be passed out of Congress on Iran," Sofer says. But it'd be a really tough battle, one that would consume a lot of energy and lobbying effort that Democrats might prefer to spend pushing on other issues. "I'm not really sure they're going to be willing to take on a fight about an Iran sanctions bill," Sofer concludes. "I'm not really sure that the Democrats who support [a deal] are really fully behind it enough that they'll be willing to give up leverage on, you know, unemployment insurance or immigration status — these bigger issues for most Democrats." So if the new Republican Senate prioritizes destroying an Iran deal, Obama will have to fight very hard to keep it — without necessarily being able to count on his own party for support. And the stakes are enormous: if Iran's nuclear program isn't stopped peacefully, then the most likely outcomes are either Iran going nuclear, or war with Iran. The administration believes a deal with Iran is their only way to avoid this horrible choice. That's why it's been one of the administration's top priorities since day one. It's also why this could become one of the biggest legislative fights of Obama's last two years. Nuke war Philip Stevens 13, associate editor and chief political commentator for the Financial Times, Nov 14 2013, “The four big truths that are shaping the Iran talks,” http://www.ft.com/cms/s/0/af170df6-4d1c-11e3-bf32-00144feabdc0.html six-power negotiations with Tehran to curb Iran’s nuclear programme may yet succeed or fail. But wrangling between the US and France on the terms of an acceptable deal should not allow the trees to obscure the forest. The organising facts shaping the negotiations have not changed.¶ The first of these is that Tehran’s acquisition of a bomb would be more than dangerous for the Middle East and for wider international security. It would most likely set off a nuclear arms race that would see Saudi Arabia, Turkey and Egypt signing up to the nuclear club. The nuclear non-proliferation treaty would be shattered. A future regional conflict could draw Israel into launching a pre-emptive nuclear strike. This is not a region obviously susceptible to cold war disciplines of deterrence.¶ The second ineluctable reality is that Iran has mastered the nuclear cycle. How far it is from building a bomb remains a subject of debate. Different intelligence agencies give different answers. The who-said-what game about last weekend’s talks in Geneva has become a distraction. The These depend in part on what the spooks actually know and in part on what their political masters want others to hear. The progress of an Iranian warhead programme is one of the known unknowns that have often wreaked havoc in this part of the world.¶ Israel points to an imminent threat. European agencies are more relaxed, suggesting Tehran is still two years or so away from a weapon. Western diplomats broadly agree that Ayatollah Ali Khamenei has not taken a definitive decision to step over the line. What Iran has been seeking is what diplomats call a breakout capability – the capacity to dash to a bomb before the international community could effectively mobilise against it.¶ The third fact – and this one is hard for many to swallow – is that neither a negotiated settlement nor the air strikes long favoured by Benjamin Netanyahu, Israel’s prime minister, can offer the rest of the world a watertight insurance policy.¶ It should be possible to construct a deal that acts as a plausible restraint – and extends the timeframe for any breakout bombing Iran’s nuclear sites could certainly delay the programme, perhaps for a couple of years. But, assuming that even the hawkish Mr Netanyahu is not proposing permanent war against Iran, air strikes would not end it.¶ You cannot bomb knowledge and technical expertise. To try would be to empower those in Tehran who say the regime will be safe only when, like North Korea, it has a weapon. So when Barack Obama says the US will never allow Iran to get the bomb he is indulging in, albeit – but no amount of restrictions or intrusive monitoring can offer a certain guarantee against Tehran’s future intentions.¶ By the same token, The best the international community can hope for is that, in return for a relaxation of sanctions, Iran will make a judgment that it is better off sticking with a threshold capability. To put this another way, if Tehran does step back from the nuclear brink it will be because of its own calculation of the balance of advantage.¶ The fourth element in this dynamic is that Iran now has a leadership that, faced with the severe and growing pain inflicted by sanctions, is prepared to talk. There is understandable, wishful thinking.¶ nothing to say that Hassan Rouhani, the president, is any less hard-headed than previous Iranian leaders, but he does seem ready to weigh the options. Yes war and extinction Wittner 11 Lawrence Wittner is Professor of History emeritus at SUNY/Albany "Is a Nuclear War With China Possible?" 11/30/2011 www.huffingtonpost.com/lawrence-wittner/nuclearwar-china_b_1116556.html While nuclear weapons exist, there remains a danger that they will be used. After all, for centuries international conflicts have led to wars, with nations employing their deadliest weapons. The current deterioration of U.S. relations with China might end up providing us with yet another example of this phenomenon.The gathering tension between the United States and China is clear enough . Disturbed by China's growing economic and military strength, the U.S. government recently challenged China's claims in the South China Sea, increased the U.S. military presence in Australia, and deepened U.S. military ties with other nations in the Pacific region. According to Secretary of State Hillary Clinton, the United States was "asserting our own position as a Pacific power." But need this lead to nuclear war?Not necessarily. And yet, there are signs that it could. After all, both the United States and China possess large numbers of nuclear weapons. The U.S. government threatened to attack China with nuclear weapons during the Korean War and, later, during their conflict over the future of China's offshore islands, Quemoy and Matsu. In the midst of the latter confrontation, President Dwight Eisenhower declared publicly, and chillingly, that U.S. nuclear weapons would "be used just exactly as you would use a bullet or anything else." Of course, China didn't have nuclear weapons then. Now that it does, perhaps the behavior of national leaders will be more temperate. But the loose nuclear threats of U.S. and Soviet government officials during the Cold War, when both nations had vast nuclear arsenals, should convince us that, even as the military ante is raised, nuclear saber-rattling persists .Some pundits argue that nuclear weapons prevent wars between nuclear-armed nations; and, admittedly, there haven't been very many -- at least not yet. But the Kargil War of 1999, between nuclear-armed India and nuclear-armed Pakistan, should convince us that such wars can occur. Indeed, in that case, the conflict almost slipped into a nuclear war. Pakistan's foreign secretary threatened that, if the war escalated, his country felt free to use "any weapon" in its arsenal. During the conflict, Pakistan did move nuclear weapons toward its border, while India , it is claimed, readied its own nuclear missiles for an attack on Pakistan .At the least, though, don't nuclear weapons deter a nuclear attack? Do they? Obviously, NATO leaders didn't feel deterred, for, throughout the Cold War, NATO's strategy was to respond to a Soviet conventional military attack on Western Europe by launching a Western nuclear attack on the nuclear-armed Soviet Union. Furthermore, if U.S. government officials really believed that nuclear deterrence worked, they would not have resorted to championing "Star Wars" and its modern variant, national missile defense. Why are these vastly expensive -- and probably unworkable -- military defense systems needed if other nuclear powers are deterred from attacking by U.S. nuclear might?Of course, the bottom line for those Americans convinced that nuclear weapons safeguard them from a Chinese nuclear attack might be that the U.S. nuclear arsenal is far greater than its Chinese counterpart . Today, it is estimated that the U.S. government possesses over 5,000 nuclear warheads, while the Chinese government has a total inventory of roughly 300. Moreover, only about 40 of these Chinese nuclear weapons can reach the United States. Surely the United States would "win" any nuclear war with China. But what would that entail? An attack with these Chinese nuclear weapons would immediately slaughter at least 10 million Americans in a great storm of blast and fire, while leaving many more dying horribly of sickness and radiation poisoning. The Chinese death toll in a nuclear war would be far higher. Both nations would be reduced to smoldering, radioactive wastelands. Also, radioactive debris sent aloft by the nuclear explosions would blot out the sun and bring on a "nuclear winter" around the globe -- destroying agriculture, creating worldwide famine, and generating chaos and destruction. "victory" War turns structural violence Folk, 78 Professor of Religious and Peace Studies at Bethany College, 78 [Jerry, “Peace Educations – Peace Studies : Towards an Integrated Approach,” Peace & Change, volume V, number 1, Spring, p. 58] Those proponents of the positive peace approach who reject out of hand the work of researchers and educators coming to the field from the perspective of negative peace too easily forget that the prevention of a nuclear confrontation of global dimensions is the prerequisite for all other peace research, education, and action. Unless such a confrontation can be avoided there will be no world left in which to build positive peace. Moreover, the blanket condemnation of all such negative peace oriented research, education or action as a reactionary attempt to support and reinforce the status quo is doctrinaire. Conflict theory and resolution, disarmament studies, studies of the international system and of international organizations, and integration studies are in themselves neutral. They do not intrinsically support either the status quo or revolutionary efforts to change or overthrow it. Rather they offer a body of knowledge which can be used for either purpose or for some purpose in between. It is much more logical for those who understand peace as positive peace to integrate this knowledge into their own framework and to utilize it in achieving their own purposes. A balanced peace studies program should therefore offer the student exposure to the questions and concerns which occupy those who view the field essentially from the point of view of negative peace. 1NC K The aff is neoliberal as all hell – more on that later Neolib bad—questioning underlying assumptions good Naidu 1998 – Ph.D., LL.B., LL.M., Professor of Political Science at Brandon University (M.V., Peace Research 30.2, Proquest) present globalization as the positive, the constructive and the beneficial evolution of the modern age being shaped by the forces of industrialization, technologicalization and internationalization. In other words, globalization is being considered as a process that is providing solutions to serious problems of world wars, ecological disasters, transportation restrictions, cultural misunderstandings, bad use of world resources, high unemployment, Third World poverty, imbalances in international trade, and economic crises resulting out of poor investments, high interest rates and high inflation. But the question that should be raised is-- what caused these problems? Otherwise we end up All the above arguments with the logic of the tragedies caused by drunk driving. More policing, more fines, more restrictions on licensing or more punishment, while selling more alcohol, can't end the problem of drunk driving; at best, these steps can help as first aid. Only prohibiting alcohol consumption by drivers can eliminate drunk driving. In other words, rooting out the causes, not the treatment of the symptoms, can avoid diseases. Globalized military action can, at best, stop or limit war, but can't eliminate war. What causes have led to the world wars of the modern age, should be the question. Answer? Modern weapons and their enormous destructive capabilities.(f.6) And modern weapons of war are very much the products of modern industry and technology.(f.7) Modern militarization and weaponry of mass destruction are now threatening the very existence of life on earth. What factors have caused today's life endangering phenomena ofecological disasters--the depletion of the ozone layer, the warming of the global temperature,(f.8) the dead rivers, lakes and oceans, deforestation, the poisoned fruits, fishes and food grains, and species extinction? Worldwide reckless massive industrialization and dehumanized science-technology. By dehumanization I mean the total concentration of the industries on power and profit to the almost total exclusion of concerns for human health and happiness in terms of physical, emotional, intellectual and economic well-being. modern facilities of ships, planes, trains and trucks, essentials of modern industrialization and products of modern technology, have globalized transportation, they have also globalized the shipment of arms , military equipment, war While tanks, battleships, submarines, bombers,(f.9) and transportation, in a matter of hours or days, of thousands of troops to wage wars in every nook and corner of the world. Besides, the massive increase in the numbers and accidents in transportation have been causing unprecedented damages to economic wealth, human health and the global ecology.(f.10) Before the advent of modern technology and industry, knowledge, especially in the realms of the histories, the religions and the cultures of the peoples of the world, was seriously limited. Consequently, international understanding was lacking. However, misunderstanding was not then a problem. But thanks to the globalization of the modern modes and instruments of mass communications--from the printing press to computer chips and communication satellites--the necessary concomitants of massive industrialization--powerful techniques of propaganda, thought control and brainwashing have been globalized. The evils of ethnicism, racism, religionism, chauvinism and jingoism(f.11) are now spread worldwide through the instrumentality of media colonialism.(f.12) An accounting of the world's natural resources today reveals the realities that the global resources have either been unused or misused, maldeveloped or mismanaged, distorted or depleted. This globalization of resource misuse or destruction is the very result of unscrupulous exploitation of the globalized colonialism. Neo-colonialism is now proclaiming that globalization of natural resources is good for all. In other words, neo-colonialism is spreading the deceptive slogan that what is good for the developed states is also good for the poor states. The haunting fact is that out of 185 states in the world, almost 40% of world resources are used up by just one country--the United States. Can we name one politician in the United States, or in any of the developed states, whose argument that Third World poverty cannot be eradicated except through globalized efforts hides the fact that poverty has been the very result of globalized economic exploitation for the industrial development of the Western world. As the only campaign slogan is--"vote for me and I promise to reduce your standards of living?" The U S hegemony is globalized superpower, the nited tates now . Remember, the sun never sets on the globalized British Empire! The old imperialists now call themselves G-7 or G-8, the OECD countries, the developed states, the donor nations, the money lenders to the World Bank and the International Monetary Fund. The old victims of colonial exploitation have been given new names--the protectorates, the military allies, the satellites, the Mandates of the League of Nations, the Trust Territories of the United Nations, the client states, the recipients of development assistance, and so on. Modern mass industrialization has always resulted in colonialism , i.e., the exploitation and impoverishment of the masses through deception, coercion and political domination by an elite that works for the enrichment of a handful of captains of industry and for the benefit of the ruling class.(f.13) In its early stage colonialism was domestic, i.e., within the political boundaries of the country. The victims were the landless peasantry, the slaves bought or captured, the ethnic and religious minorities, destitute women and children, and the undeveloped regions in the country. These victims were best portrayed by the British novelist Charles Dickens and by American writers like Jane Addams. As industrialization advanced, colonial exploitation reached foreign conquests and occupations of territories in Asia, Africa and the Western Hemisphere created colonies(f.14) that became the backbone of European industrialization by supplying vast natural resources(f.15), enormous slave or cheap labor, millions of captive consumers, and tremendous opportunities for trade, investment,(f.16) employment and emigration. lands. Military Massive industrialization is impossible without globalized colonialization. Colonialization, in turn, is unavoidable Thus domestic colonialism evolved into international colonialism. In other words, colonialism was globalized. by globalized industrialization. Because modern economy of mass industrialization--i.e., the economy of mass production, mass distribution and mass consumption--cannot be sustained without colonial exploitation, neo-colonialism now wears the garbs of globalization--of foreign aid,(f.17) of international investment, of free trade, of technology transfer, and so on. It is an oxymoron to argue that globalized poverty and economic inequalities can be eliminated by globalized industrialization and neo-imperialism . Today one-third of the world controls three-fourths of world trade. Yet this phenomenon is considered a reflection of beneficial globalization whose advocates are now calling for further globalization through expanded free-market economies. Economically developed countries benefit through unrestricted trade in two ways: one, they are ever ready to buy or secure raw materials from the Third World countries, but not their finished products. The other, they have enormous surpluses of finished products to sell to the developing countries. These proponents have already set up free trade zones like the Canada-U.S. Free Trade agreement, NAFTA, the European Common Market, the OECD, the World Trade Organization, etc. The globalization of free trade is undoubtedly to the advantage of the developed states. On the other hand, the less developed states that cannot earn much through international trade can ill afford to buy foreign goods. If they do buy, out of pressure or unavoidability, they become heavily indebted.(f.18) These debts, in turn, retard their economic development. More than this, the less developed industries of the Third World that cannot compete, either in quality or in quantity, with the products from developed economies, need protection. In the words of Kaiser, free trade is the weapon of the strong, and protectionism is the shield of the weak. As long as economic inequalities exist in the world, and as long as the rich and developed states insist on improving or sustaining their own development, globalization of free trade will never bring about equitable trade among all states of the world. In every case of massive industrialization, some groups and regions within and without the state always end up as the victims suffering trade inequalities. Another tragic consequence that is often played down by the advocates of massive industrialization is the fact that the more technological and industrialized an economy becomes, the more susceptible it s economy becomes to increased unemployment. Irrespective of all the complex and complicated explanations offered by the sophisticated economists with econometric models, the simple truth behind unemployment is the fact that mechanization displaces workers; automation decreases human employment by making workers surplus or redundant.(f.19) Advanced industrialization, whether under capitalism, communism or fascism, becomes dehumanized when it pays least or no attention to the fate of the workers and the problems of the unemployed. Instead, its main focus is on the twin goals of increasing productivity and competitiveness, both of which mean higher levels of mechanization, automation and rationalization, leading inevitably to lower levels of employment. When European industrialization during the 18th and 19th centuries made workers redundant, Europe got rid of the surplus of the unemployed and the unemployable population in more than one way. The main method of reducing the unemployable and the unwanted was sending them away to new colonies in the Western Hemisphere, Africa, Asia, Australia, New Zealand, and so on. Today people of European ancestry--pure or mixed--living outside Europe amount to hundreds of millions. Most of the European emigrants were peasants, unemployed workers and artisans, criminals, social misfits and exploited ethnic, racial, and religious minorities. These colonies of Europeans not only saved and supported European industries by absorbing the unwanted population of Europe, the colonies also boosted European industrialization by becoming suppliers of raw materials, primary industries, cheap labor, huge markets, big profits, large investment and employment opportunities. Besides, the colonies also provided arms, armies(f.20) and battlefields, thereby enhancing the military capability to fight colonial wars,(f.21) to defend old possessions or to acquire new territories. These factors further boosted European commerce, diplomacy and international power status . As profitability of mass industries leads to huge capital surpluses, need arises for investment opportunities. Of course, only the rich nations and the wealthy multinational corporations (MNCs) seek outlets for their surplus wealth. The recipients for such investments are always the poor and the not-so-rich nations. The current euphemisms for such surplus trade and investments are foreign aid, development loans, technological assistance, free markets, financial assistance from the World Bank or International Monetary Fund, and so on. The recent proposal called the Multinational Agreement on Investments (MAI) by the Organization for Economic Co-operation and Development (OECD), consisting of the 29 richest nations in the world, is a good example of the latest neo-colonial machinations.(f.22) While proclaiming pious platitudes of humanitarianism, the lenders and investors, , of course work for their own profitability. It is like my banker who lends me money and seeks high interest and a mortgage on everything I own, and then claims that he was doing me a favor, while awaiting to confiscate my possessions the moment I fail to make the payments. Without the opportunities to substantially increase my earnings, I end up being at the mercy of the bank, borrowing more to pay the interest on previous borrowings. My banker Shylock will not hesitate to demand his pound of my flesh! Should I feel grateful to this Globalization of trade, investment and banking(f.23) can only mean further dictation and domination of the developed countries and further indebtedness and impoverishment of the undeveloped or developing Shylock? countries. The globalized Shylock will undoubtedly demand the pound of flesh from the globalized debtors. Countries like the G-7 that manipulate interest rates, stock markets, currency values, inflation, deflation, etc. The recent episodes of the financial collapse of the seemingly thriving industrialization and economies of countries like South Korea, Thailand, Malaysia and Indonesia stand as testimony to the fact that the so-called development of the dependent economies can be flimsy(f.24), deceptive, corrupt and dehumanized . Thus the globalization of the financial markets simply means the strengthening of the stranglehold that the developed world has on the economies of the underdeveloped world. There is no gainsaying that wars, ecological disasters, transportation bottlenecks, cultural misunderstandings and brainwashing have become globalized. The root causes of these problems are massive and dehumanized technology and industrialization. Similarly, the evils of globalized poverty and economic inequalities, globalized misuse of world resources and international trade, and globalized manipulation of the world's investments and financial markets are the results of massive industrialization and colonialism and neocolonialism--domestic and external. The antidote for these cases of economic globalization is not more globalization, but less of it. The distinction between "globalization from the top" and "globalization from the bottom" is false. The premise that we can evolve a "globalized civil society" out of the "globalized militaristic society" is misleading. Superficial globalized counter-moves for immediate solutions can only be counter-productive. The target of attack for the evils of globalization should be globalization, through in-depth and long-term measures, not through band-aid treatments. In order to reduce and eliminate the root causes, measures should be initiated to reduce in varying stages the current levels of technologicalization, industrialization and dehumanization of world economies. This means decentralization, devolution and indiginization of huge economies into small-scale and self-sustaining economies. Such small economies will only need small-sized and self-governing polities. In a word, small can be beautiful. Reduction in the economicpolitical system implies fundamental changes at the intellectual and cultural level--a reduction in the aspiration of material wealth, greed and selfishness, and an expansion in the values of co-operation, compassion and humanism. These changes in politico-economic-cultural aspects of life necessitate a paradigm shift. Two main arguments can be raised control most of the world's trade, investment and lending, indirectly control the world's financial markets; they can against the proposed paradigm shift. One, science-technology and industry are not inherently negative or immoral, because they are non-human and therefore amoral. It is their misuse or misdirection that causes problems discussed above. The other, reduction or elimination of massive industrialization and technologicalization is neither practical nor desirable. The first argument is falsely formulated because the criticism of science-technology and industry per se; the criticism is of their massiveness and their dehumanization. When their impacts on human life and well-being are deliberately is not disregardedby those who use them, then science-technology and industry become dehumanized and cause all the evils of our modern age. It may be argued that science-technology and industry by themselves are not harmful or immoral. This argument is similar to the one which says that a sword by itself does not kill people; people using it kill people. Therefore the sword is amoral! But in the human context, the very purpose (telos) in the creation of the sword is to inflict physical harm or death on human beings. The sword is not meant to till the soil. It is not built to serve as a crutch for a lame person. The destructive purpose of the sword will not change until it is beaten into a ploughshare. But when it becomes a ploughshare, it is not a sword by definition. For modern science-technology and mass industries power and profit have become the driving forces, and materialism has become the cherished goal. Power is the capacity of A to influence, persuade, dominate, coerce or force B so as to make B do or not do something according to the will of A. Profit reflects the drive and the desire to buy, acquire or possess material wealth. The craze for power, pelf or profit, either at the personal or national level, usually resorts to unscrupulousness, exploitativeness and immorality. Obsession with materialism devalues intellectual or spiritual goals and induces instinctual behavior, thereby reducing Homo sapiens to the level of beasts. Thus dehumanized who argue that limiting globalization of science-technology and industry is impractical and hence impossible, seem to adhere to the doctrines of fatalism or predestination or historicism similar to the Augustinian concept of science-technology and industries would cause greater harm when further globalized. Those original sin and damnation, or Herbert Spencer's concept of social Darwinism, or the Marxist concept of historical materialism or the evolutionist concept of unidirectional linear progression. Though raised in the name of realism, none of these concepts are rational, real or proven; all of them are cynical or pessimistic. Does the argument of impracticality mean the inevitability of globalized selfdestruction of humanity? Cannot human Karma (action) play a part in shaping human destiny? Is it unrealistic to believe that human suffering and destruction can be limited, reduced or eliminated through deglobalization of weapons and wars, and through deglobalization of political oppression, economic exploitation, and environmental degradation? When someone claims to be "practical," she really means that she will get what she wants by hook or crook. In this sense, any means whatsoever could be employed to achieve the ends one desires. That is, the ends should not determine in any way the means to be employed. This approach, thus sets up a dichotomy between ends and means. Further, when someone argues that something is impractical, she really means she cannot be successful in attaining her goals. In this sense, success is the essential consideration. The argument that there is no interrelatedness between ends and means is a false dichotomy. The seed predetermines the nature of the tree, the flower and the fruit, the results. Similarly, hate-filled or violent or immoral means are bound to lead to results that endorse or establish hatred or violence or immorality. When people are obsessed with success, they want to get what they want within a prescribed or a short period of time, and if they cannot, then they won't even try. When effort is enslaved to success, human will loses its autonomy; and pessimism and cynicism that set in rob humanity of its challenge and dynamism. To avoid such losses, we should focus upon and emphasize the view that effort is essential, not the result, that struggle is important, not the success! For the cynics, being "practical" means being successful in achieving any goal by any means. Success is critical; means could be immoral or amoral. The Gandhian paradigm of "practical idealism" overcomes both the problems of bad means and of obsession with success. The paradigm avoids the artificial dichotomy between ends and means by postulating that moral means are essential for moral goals; the formulation avoids cynicism and frustration by focusing on the struggle without any concern over its success, and by prescribing modest measures that are feasible in a given situation. The Gandhian paradigm can be translated into two simple phrases--"Think morally and act morally," and "Think globally and act locally." In fine, deglobalization of dehumanized science-technology and mass industrialization can be pursued through practical idealism. In conclusion, globalization is not the panacea for the world crises; instead it is the deepening of the crises. The answer to the problems of globalization is decrease, not increase, in globalization. Rehumanization of science-technology and industrialization is the permanent panacea for the 21st century. Vote neg to reject the neoliberal paradigm. Refusing narratives of inevitability and legitimation best for political engagement. Hay, PHD POLSIS, University of Birmingham, Edgbaston, Birmingham 2004 (Colin, Economy and Society Volume 33 Number 4 November 2004: 500-527 p.523-4) Accordingly, however depoliticized and normalized neoliberalism has become, it remains a political and not a simple necessity. This brings us naturally to the question of alternatives. A number of points might here be made which follow fairly directly from the above analysis. First, our ability to offer alternatives to neoliberalism rests now on our ability to identify that there is a choice in such matters and, in so doing, to demystify and deconstruct the rationalist premises upon which its public legitimation has been predicated. This, it would seem, is a condition of the return of a more normative and engaging form of politics in which more is at stake than the personnel to administer a largely agreed and ostensibly technical neoliberal reform agenda. Second, the present custodians of neoliberalism are, in many cases, reluctant converts, whose accommodation to neoliberalism is essentially borne of perceived pragmatism and necessity rather than out of any deep normative commitment to the sanctity of the market. Thus, rather than defend neoliberalism publicly and in its own terms, they have sought instead to appeal to the absence of a choice which might be defended in such terms. Consequently, political discourse is technocratic rather than political. Furthermore, as Peter Burnham has recently noted, neoliberalism is itself a deeply depoliticizing paradigm (2001), whose effect is to subordinate social and political priorities, such as might arise from a more dialogic, responsive and democratic politics, to perceived economic imperatives and to the ruthless efficiency of the market. As I have sought to demonstrate, this antipathy to ‘politics’ is a direct correlate of public choice theory’s projection of its most cherished assumption of instrumental rationality onto public officials. This is an important point, for it suggests the crucial role played by stylized rationalist assumptions, particularly (as in the overload thesis, public choice theory more generally and even the time-inconsistency thesis) those which relate to the rational conduct of public officials , in contributing to the depoliticizing dynamics now reflected in political disaffection and disengagement. As this perhaps serves to indicate , seemingly innocent assumptions may have alarmingly cumulative consequences. Indeed, the internalization of a neoliberalism predicated on rationalist assumptions may well serve to render the so-called ‘rational voter paradox’ something of a self-fulfilling prophecy.12 The rational voter paradox / that in a democratic polity in which parties economic choice, behave in a ‘rational’ manner it is irrational for citizens to vote (since the chances of the vote they cast proving decisive are negligible) / has always been seen as the central weakness of rational choice theory as a set of analytical techniques for exploring electoral competition. Yet, as the above analysis suggests, in a world constructed in the image of rationalist assumptions, it may become depressingly accurate. Political parties behaving in a narrowly ‘rational’ manner, assuming others (electors and market participants) to behave in a similarly ‘rational’ fashion will contribute to a dynamic which sees real electors (rational or otherwise) disengage in increasing numbers from the facade of electoral competition. That this is so is only reinforced by a final factor. The institutionalization and normalization of neoliberalism in many advanced liberal democracies in recent years have been defended in largely technical and rationalist terms and in a manner almost entirely inaccessible to public political scrutiny, contestation and debate. The electorate, in recent years, has not been invited to choose between competing programmatic mandates to be delivered in office, but to pass a judgement on the credibility and competence of the respective candidates for high office to behave in the appropriate (technical) manner in response to contingent external stimuli. Is it any wonder that they have chosen, in increasing numbers, not to exercise any such judgement at all at the ballot box? As this final point suggests, the rejection of the neoliberal paradigm, the demystification of its presumed inevitability and the rejection of the technical and rationalist terms in which that defence has been constructed are intimately connected. They are, moreover, likely to be a condition not only of the return of normative politics but also of the re-animation of a worryingly disaffected and disengaged democratic culture. 1NC CP Text: The fifty states should, through the National Conference of Commissioners on Uniform Law, amend the Uniform Anatomical Gift Act to require routine recovery of cadaveric organs in the event of brain death, subject only to application for religious exemption. The United States should recognize property rights regarding the donation of human tissue for scientific or clinical ends, but criminalize the sale of human organs. Organ draft solves case and avoids exploitation DA Spital, 7 - Department of Medicine, Mount Sinai School of Medicine, New York, New York (Aaron, “Routine Recovery of Cadaveric Organs for Transplantation: Consistent, Fair, and LifeSaving” CJASN March 2007 vol. 2 no. 2 300-303, doi: 10.2215/CJN.03260906) Transplant candidates and the people who care for them know only too well that there is a severe shortage of acceptable organs. As a result, in the United States alone, approximately 19 people on the transplant waiting list die every day (1). Compounding this tragedy is the fact that many potentially life-saving cadaverica organs are not procured (2). Clearly, our organ procurement system fails to meet our needs. Recognition of this failure has led to several radical proposals designed to increase the number of organs that are recovered for transplantation, including legalization of organ sales (3) and offering priority status to people who agree to posthumous organ recovery (4). But before reaching for a new approach, we need to ask first, “What is wrong with our current cadaveric organ procurement system?” The Need for Consent: Widely Accepted but Sometimes Deadly We believe that the major problem with our present cadaveric organ procurement system is its absolute requirement for consent. As such, the system’s success depends on altruism and voluntarism. Unfortunately, this approach has proved to be inefficient. Despite tremendous efforts to increase public commitment to posthumous organ donation, exemplified most recently by the US Department of Health and Human Services sponsored Organ Donation Breakthrough Collaborative (5), many families who are asked for permission to recover organs from a recently deceased relative still say no (2). The result is a tragic syllogism: nonconsent leads to nonprocurement of potentially life-saving organs, and nonprocurement limits the number of people who could have been saved through transplantation; therefore, nonconsent results in loss of life. In an attempt to overcome this consent barrier while retaining personal control over the disposition of one’s body after death, several countries have enacted “opting-out” policies, sometimes referred to (erroneously, we believe) as presumed consent (6). Under these plans, cadaveric organs can be procured for transplantation unless the decedent—or her family after her death—had expressed an objection to organ recovery. Although there is evidence that this approach increases recovery rates, perhaps by changing the default from nondonation to donation (7,8), the recent Institute of Medicine (IOM) report on organ donation concluded that a presumed consent policy should not be adopted in the United States at this time (8). One of the most important concerns noted by the IOM committee is the results of a 2005 survey in which 30% of the respondents said that they would opt out under a presumed consent law. The IOM report also pointed out that in the United States there seems to be a lack of public support for this approach, that the organ donation rate in the United States currently exceeds that of many countries with presumed consent policies, and that in most of these countries the family of the decedent is still consulted (8). It should also be noted that even optingout countries do not have enough organs to meet their needs, and for people who remain unaware of the plan, presumed consent becomes routine recovery in disguise. Given that some people do not want to donate, it is clear that whether we follow an opting-in or an opting-out approach, life-saving organs are and will continue to be lost because of refusals. In other words, the requirement for consent, whether explicit or presumed, is responsible for some deaths. But isn’t this the price that we must pay to show respect for people after they die? We believe that the answer is no. The view that consent is an absolute requirement for cadaveric organ recovery has long been accepted as self-evident, and few experts in the field have seen the need to justify it. We agree that the premortem wishes of the deceased regarding the postmortem disposition of his or her property should generally be respected. However, we believe that the obligation to honor these (or the family’s) wishes is prima facie, not absolute, and that it ceases to exist when the cost is unnecessary loss of human life, which is often precisely what happens when permission for organ recovery is denied. Therefore, given the current severe organ shortage and its implications for patients who are on the waiting list, we propose that the requirement for consent for cadaveric organ recovery be eliminated and that whenever a person dies with transplantable organs, these be recovered routinely (9–11). Consent for such recovery should be neither required nor sought. In our opinion, the practical and ethical arguments for this proposal are compelling. Routine Removal: Consistency with Other Socially Desirable but Intrusive Programs One of the major reasons for insisting on consent is to show respect for autonomy, a major principle of biomedical ethics. However, Beauchamp and Childress (12) pointed out that as important as this principle is, it “has only prima facie standing and can be overridden by competing moral considerations.” One such consideration occurs when society is so invested in attaining a certain goal that is designed to promote the public good that it mandates its citizens to behave in a manner that increases the probability of achieving that goal, even though many of them would prefer not to act in this way. Silver (13) pointed out the legitimacy of this approach in his discussion of an “organ draft”: “The sense behind the coercive power of democratic governments is to move society forward by public decree where individuals will not, by private volition, act in their own best interests.” Examples of such situations include a military draft during wartime, taxation, mandatory vaccination of children who attend public school, jury duty, and, perhaps most relevant to routine removal of cadaveric organs, mandatory autopsy when foul play is suspected. Although some people may not like the fact that they have no choice about these programs, the vast majority of us accept their existence as necessary to promote the common good. Routine removal of cadaveric organs would be consistent with this established approach, and it would save many lives at no more (and we believe much less) cost than these other mandated programs. Furthermore, had we been born into a world where cadaveric organ removal for transplantation were routine, it is likely that few if any people would question the policy, just as few of us question mandatory autopsy today. And while most of us will never need a transplant, nonrecipients would also benefit from the plan in the same way that people who never file a claim benefit from the security of having insurance. It should also be noted here that, as discussed below, a person’s autonomy is lost after death. Recovering Cadaveric Organs without Consent: Life-Saving and Fair Few would argue against the view that routine removal of usable cadaveric organs would save many lives. Under such a program, recovery of transplantable organs should approach 100%. It is unlikely that any program designed to increase consent rates could even come close. Although the expected high efficiency of routine recovery is its major raison d’être, it also has several other advantages. Routine recovery would be much simpler and cheaper to implement than proposals designed to stimulate consent because there would be no need for donor registries, no need to train requestors, no need for stringent governmental regulation, no need to consider paying for organs, and no need for permanent public education campaigns. The plan would eliminate the added stress that is experienced by some families and staff who are forced to confront the often emotionally wrenching question of consent for recovery. Delays in the removal of transplantable organs, which sometimes occur while awaiting the family’s decision and which can jeopardize organ quality, would also be eliminated. A final advantage of routine posthumous organ recovery is that it is more equitable than are systems that require consent. All people would be potential contributors, and all would be potential beneficiaries. No longer could one say, “Thank you,” when offered an organ but say, “No,” when asked to give one; such “free riders” would be eliminated. And concern about exploitation of the poor, as sometimes arises during discussions of organ sales, is not an issue here. RISK FRAMING They’re wrong about predictions and voting for them makes it worse Fitzsimmons, 7 – Ph.D. in international security policy from the University of Maryland, Adjunct Professor of Public Policy, analyst in the Strategy, Forces, and Resources Division at the Institute for Defense Analyses (Michael, “The Problem of Uncertainty in Strategic Planning”, Survival, Winter 06/07) In defence of prediction Uncertainty is not a new phenomenon for strategists. Clausewitz knew that ‘many intelligence reports in war are contradictory; even more are false, and most are uncertain’. In coping with uncertainty, he believed that ‘what one can reasonably ask of an officer is that he should possess a standard of judgment, which he can gain only from knowledge of men and affairs and from common sense. He should be guided by the laws of probability.’34 Granted, one can certainly allow for epistemological debates about the best ways of gaining ‘a standard of judgment’ from ‘knowledge of men and affairs and from common sense’. Scientific inquiry into the ‘laws of probability’ for any given strate- gic question may not always be possible or appropriate. Certainly, analysis cannot and should not be presumed to trump the intuition of decision-makers. Nevertheless, the burden of proof in any debates about planning should belong to the decision-maker who rejects formal analysis, standards of evidence and probabilistic reasoning. Ultimately, though, the value of prediction in strategic planning does not rest primarily in getting the correct answer, or even in the more feasible objective of bounding the range of correct answers. Rather, prediction requires decisionmakers to expose, not only to others but to themselves, the beliefs they hold regarding why a given event is likely or unlikely and why it would be important or unimportant. Richard Neustadt and Ernest Clausewitz’s implication seems to be that May highlight this useful property of probabilistic reasoning in their renowned study of the use of history in decision-making, Thinking in Time. In discussing the importance of probing presumptions, they contend: The need is for tests prompting questions, for sharp, straightforward mechanisms the decision makers and their aides might readily recall and use to dig into their own and each others’ presumptions. And they need tests that get at basics somewhat by indirection, not by frontal inquiry: not ‘what is your inferred causation, General?’ Above all, not, ‘what are your values, Mr. Secretary?’ ... If someone says ‘a fair chance’ ... ask, ‘if you were a betting man or woman, what odds would you put on that?’ If others are present, ask the same of each, and of yourself, too. Then probe the differences: why? This is tantamount to seeking and then arguing assumptions underlying different numbers placed on a subjective probability assessment. We know of no better way to force clarification of meanings while exposing hidden differences ... Once differing odds have been quoted, the question ‘why?’ can follow any number of tracks. Argument may pit common sense against common sense or analogy against analogy. What is important is that the expert’s basis for linking ‘if’ with ‘then’ gets exposed to the hearing of other experts before the lay official has to say yes or no.’35 There are at least prediction enforces a certain level of discipline in making explicit the assumptions, key variables and implied causal relationships that constitute decision-makers’ beliefs and that might otherwise remain implicit. Imagine, for example, if Shinseki and Wolfowitz had been made to assign probabilities to their opposing expectations regarding post-war Iraq. Not only would they have had to work harder to justify their views, they might have seen more clearly the substantial chance that they were wrong and had to make greater efforts in their planning to prepare for that contingency . Secondly, the very process of making the relevant factors of a decision explicit provides a firm , or at least transparent, basis for making choices. Alternative courses of action can be compared and assessed in like terms. Third, the transparency and discipline of the process of arriving at the initial strategy should heighten the decision-maker’s sensitivity toward changes in the environment that would suggest the need for adjustments to that strategy. In this way, prediction enhances rather than under-mines strategic flexibility. This defence of prediction does not imply that great stakes should be gambled on narrow, singular predictions of the future. On the three critical and related benefits of prediction in strate- gic planning. The first reflects Neustadt and May’s point – contrary, the central problem of uncertainty in plan- ning remains that any given prediction may simply be wrong. Preparations for those eventualities must be made. Indeed, in many cases, relatively unlikely outcomes could be enormously consequential, and therefore merit extensive preparation and investment. In order to navigate this complexity, While the complexity of the international security environment may make it somewhat resistant to the type of probabilistic thinking associated with risk, a risk-oriented approach seems to be the only viable model for national-security strategic planning. The alternative approach, which categorically denies prediction, precludes strategy. As Betts argues, Any assumption that some knowledge, whether intuitive or explicitly formalized, provides guidance about what should be done is a presumption strategists must return to the dis- tinction between uncertainty and risk. that there is reason to believe the choice will produce a satisfactory outcome – that is, it is a prediction, however rough it may be. If there is no hope of discerning and manipulating causes to produce intended effects, analysts as well as politicians and generals should all quit and go fishing.36 Unless they are willing to quit and go fishing, then, strategists must sharpen their tools of risk assessment. Risk assessment comes in many varieties, but identification of two key parameters is common to all of them: the consequences of a harmful event or condition; and the likelihood of that harmful event or condition occurring. With no perspective on likelihood, a strategist can have no firm perspective on risk. With no firm perspective on risk, strategists cannot purposefully discriminate among alternative choices. Without purposeful choice, there is no strategy. One of the most widely read books in recent years on the complicated relation- ship between strategy and uncertainty is Peter Schwartz’s work on scenario-based planning, The Art of the Long View. Schwartz warns against the hazards faced by leaders who have deterministic habits of mind, or who deny the difficult implications of uncertainty for strategic planning. To overcome such tenden- cies, he advocates the use of alternative future scenarios for the purposes of examining alternative strategies. His view of scenarios is that their goal is not to predict the future, but to sensitise leaders to the highly contingent nature of their decision-making.37 This philosophy has taken root in the strategicplanning processes in the Pentagon and other parts of the US government, and properly so. Examination of alternative futures and the potential effects of surprise on current plans is essential. Appreciation of uncertainty also has a number of organisational impli- cations, many of which the national-security establishment is trying to take to heart, such as encouraging multidisciplinary study and training, enhancing information sharing, rewarding innovation, and placing a premium on speed and versatility. The arguments advanced here seek to take nothing away from these imperatives of planning and operating in an uncertain environment. But appreciation of uncertainty carries hazards of its Questioning assumptions is critical, but assumptions must be made in the end. own. Clausewitz’s ‘standard of judgment’ for discriminating among alternatives must be applied. Creative, unbounded speculation must resolve to choice or else there will be no strategy. Recent history suggests that unchecked scepticism regarding the validity of prediction can marginalise analysis, empower parochial interests in decision-making, and undermine trade significant cost for ambig- uous benefit, flexibility. Accordingly, having fully recognised the need to broaden their strategic-planning aperture, national-security policymakers would do well now to reinvigorate their efforts in the messy but indispensable business of predicting the future. TRAFFICKING Global norms against sales are solidifying now and it’s decreasing the black market and transplant tourism – but it’s reversible if the US legalizes organ sales Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25) India was one of about fifty countries that undertook to reform their practices following the approval of WHO’s original Guiding Principles. These countries adopted laws in the early 1990s to institute the anticommercial system recommended by WHO. Similarly, a number of countries—including several that were centers for organ sales, such as Pakistan and the Philippines, and other countries, such as Israel, that had sent large numbers of “transplant tourists” abroad to receive vended kidneys40— have adopted laws and regulations in the past few years that aim to put the 2010 WHO Guiding Principles into effect. 41 These changes have been strongly supported by other intergovernmental bodies such as the United Nations,42 the Council of Europe,43 and the UN Office on Drugs and Crime,44 all of which have addressed the phenomena of organ trafficking45 and of people being trafficked for the removal of the organs.46 Equally significant in driving ethical and legal reforms have been the advocacy efforts of leaders in transplantation medicine. For example, the Transplantation Society (TTS) and the International Society of Nephrology organized a global summit on organ trafficking and transplant tourism in Istanbul in late April 2008, where a statement of professional opposition to organ markets, the Declaration of Istanbul, was adopted.47 The Declaration of Istanbul has since been endorsed by more than 120 medical organizations and governmental agencies.48 Realizing that the declaration would not be selfimplementing, its creators formed the Declaration of Istanbul Custodian Group (DICG) in 2010 to encourage adherence to its principles and proposals.49 The DICG and TTS have produced some notable results by calling on government officials to adopt and enforce prohibitions, and by making clear to them the harm done to the standing of medical professionals who work in locales where organ sales are widespread.50 Furthermore, the DICG’s direct interventions to change professional practices have been even more successful.51 For instance, academic recognition has been withheld from physicians who have carried out transplants with organs from executed prisoners by barring the physicians’ abstracts from inclusion in international medical congresses.52 Many medical journals have announced that they expect adherence to the Declaration of Istanbul by their authors, just as they have long insisted that research conducted with human beings must adhere to the Declaration of Helsinki, first promulgated by the World Medical Association in 1964.53 In at least one instance, several articles were retracted from an academic journal when it was discovered that the work discussed involved living donors who had been paid to supply a kidney.54 C. Recent National Changes in Response to Global Norms Bringing about thoroughgoing changes in transplant practices requires more than academic and professional sanctions; governments must also adopt and enforce bans on organ purchases and transplant tourism . The latter has proven particularly difficult, not the least because of the built-in opposition of the people who have profited from catering to transplant tourists. Accordingly, the hard-won gains in this regard that have been achieved in the past five years are all the more remarkable. Some local proponents of organ-trade prohibitions have successfully used global standards in their transformative efforts. This is illustrated by the experiences of Pakistan where the Transplantation of Human Organs and Tissues Ordinance was adopted by presidential decree in 2007 before becoming a parliamentary act in 2010.55 Before the ordinance, an estimated 1500 patients from other countries—principally in the Middle East—as well as about 500 wealthy Pakistanis received vended kidneys each year, mainly in private hospitals and clinics in Lahore and other Punjab cities.56 The efforts to bring that practice to an end were lead by the professionals associated with the Sindh Institute of Urology and Transplantation (SIUT), a medical center in Karachi that provides donation-driven kidney dialysis and transplantation to all patients without charge. SIUT supplied the “moral entrepreneurs: groups and individuals in civil society who are committed to the elimination of trade they consider harmful and repugnant,”57 who mobilized public opposition to commercial organ donation. They urged the government to adopt the new law. Descriptions written by SIUT physicians of the socioeconomic realities of the organ trade58 and of the resulting hazards to both donors and recipients59 led to critical reporting of the practice in newspapers and on television.60 The media coverage took specific aim at the role of the government, whose failed poverty-alleviation programs left individuals no choice but to sell their kidneys, and whose failure to enact a transplant law and later to enforce it allowed the organ trade to thrive. It was also noted that reports of Pakistan’s “flourishing kidney market” had appeared in the international press, tarnishing the country’s reputation.61 The owners of the private hospitals who profited greatly from transplant commercialism and who had strong connections to highlevel officials mounted fierce opposition to the transplant bill and sought to water down its prohibitions on unrelated living donation.62 On the other side, SIUT’s founder and director, Professor Adib Rizvi, used his strong connections with international medical groups, particularly his membership in the DICG, to counteract these powerful opponents.63 Prominent transplant surgeons among the DICG leadership came to Pakistan to convince government officials that organ sales were a matter of international concern and needed to be curbed to rehabilitate the reputation of Pakistani physicians.64 As Professor Asif Esrat concludes, “For government officials, the desire to conform to widely held international norms and redeem the national reputation served as a motivation for action.”65 When the law was contested in a federal Shariat court as an interference with the Islamic duty to save life, the existence of the international standards, as embodied in the WHO Guiding Principles (which Pakistan had joined in endorsing at the World Health Assembly), weighed heavily enough that the court rejected the challenge.66 When several transplant programs continued to carry out commercial transplants, including on patients from abroad, Dr. Rizvi and his colleagues reported these violations to the authorities and prosecutions were brought against the surgeons and hospitals that had attempted to profit by breaking the law.67 The current situation in the Philippines resembles that in Pakistan in some ways but differs in significant respects. The country has been a well-known locale for organ purchases for the past several decades; indeed, it was one of the first places where the anthropologists of Organs Watch, an independent research and medical-human-rights project at the University of California, Berkeley, began their examination of the “new body trade” in which “the circulation of kidneys follows established routes of capital from South to North, from East to West, from poorer to more affluent bodies, from black and brown bodies to white ones, and from female to male or from poor, low status men to more affluent men.”68 Although Internet sites have made the Philippines another important locus for the global organ trade, the initial pattern of using vended kidneys there differed from what had occurred in Pakistan because the recipients were mainly wealthy Filipinos, not foreigners. 358 of the 468 kidney transplants recorded in 2003 by the Renal Disease Control Program of the Department of Health in the Philippines involved domestic patients (though the possibility of incomplete reporting by private hospitals cannot be totally discounted).69 It was thus not surprising that elite groups at that time supported a proposal under consideration by the government to institutionalize paid kidney donation as well as to formally accept transplantation for foreign patients.70 As appealing as this idea may have seemed to someone viewing it “from a private hospital room in Quezon City,” it was much less so for human-rights advocates trying to protect potential organ sellers in “a sewage-infested banguay (slum) in Manila.”71 These advocates used the attention that the World Health Organization was bringing to the issue at that time to halt the movement toward legalizing compensation. Over the following five years, international pressure on the government intensified, not only from intergovernmental and medical bodies72 but from the Catholic hierarchy, particularly in light of press coverage about unscrupulous organ brokers trolling in the slums for donors to meet the ever-increasing demand for kidneys coming from Manila’s transplant tourists.73 On April 30, 2008, a ministerial directive barred foreign recipients from getting kidneys from Filipino living donors.74 The next year, the Inter-Agency Council Against Trafficking followed the international trend and used the organ trafficking provisions of the Philippines’ AntiHuman Trafficking Law as the basis for supplemental regulations outlawing all organ purchases, as well as other means of trafficking persons for organ removal, including the use of force, fraud, and taking advantage of vulnerability.75 The fragility of these legal changes in the face of the determined opposition is indicated by the next swing of the Filipino organpolicy pendulum. When Benigno Aquino III assumed office as President in June 2010, he nominated as secretary of health Dr. Enrique T. Ona, a transplant surgeon who had previously expressed his opposition to the ban on organ sales.76 The nomination was held up, however, when Ona announced his intention to allow organ donors to be compensated by a $3200 “gratuity package”77 and joined several American regulated-market advocates in sponsoring an international forum on “Incentives for Donation” in Manila that November.78 He was confirmed as health minister, however, after providing assurances that he would not institute financial “gratuities,” but he did sign the proposal for incentives that emerged from the international forum.79 In effect, the pendulum has swung back, as the number of foreign transplant recipients, which had risen to 531 by 2007 before the ban, fell to two by 2011, even as a threefold increase occurred in deceased-donor transplants for Filipinos.80 Movement in the opposite direction remains possible, however, as organ purchases by wealthy Filipinos have not completely disappeared, with brokers helping potential kidney recipients persuade review committees to allow as “emotionally related” donations what are in fact commercial transactions.81 Another variation on the theme of transplant tourism has taken place in Colombia, which “was a major provider of deceased-donor organs for wealthy foreigners” during the first decade of this century,82 mainly for liver transplantation.83 With strong international and regional backing, local medical leaders succeeded in redirecting organs to recipients from Colombia and neighboring countries. The annual rate of transplantation to foreigners, which stood at 200 in 2005 (16.5% of the national total), was reduced to 10 by 2011 (0.9% of the total, down from 1.45% the prior year).84 The situation in Colombia is indicative of the progress that has been made across Latin America with the adoption by the Ibero-American Council of a set of principles and objectives in a regional parallel to the Declaration of Istanbul, the Document of Aguascalientes,85 which was encouraged through a strong alliance with the Spanish transplant program. The Document of Aguascalientes has provided legal and ethical as well as technical guidance for countries across that region as they have created or strengthened their own systems for organ donation, allocation, and transplantation that seek the support of the public and medical professionals and that aim to meet the transplant needs of the domestic population and achieve “self-sufficiency” nationally or through regional cooperation.86 Over the past five years, the most impressive examples of countries that have responded to stronger global norms regarding the opposite side of “self-sufficiency”— namely, not sending transplant tourists abroad as the means to meet domestic demand for organs— are in the Middle East. Israel’s enactment in 2008 of legislation halting insurance coverage for commercial transplants that violate local laws ended its reliance on Turkey, South Africa, China, and the Philippines, among other countries, as sites where Israeli patients could go to obtain vended kidneys.87 The law also stimulated the development of a robust system of deceased and living-related donation, which has been widely praised.88 A number of Arab countries have taken steps—thus far less sweeping in scope or impact than the Israeli program but still effective—to treat patients at home rather than sending them abroad . The evolution of policy in Qatar provides a vivid example of the competing forces at work: expediency, selfinterest, generosity, and concern about adhering to international norms. The local provider of transplant services, the Hamad Medical Corporation (HMC), has concluded that it needs to go beyond the existing Qatari program for honoring donors if it is to achieve self-sufficiency in organ transplantation.89 Consequently, the HMC increased outreach within the expatriate community in Qatar (more than 85% of residents) to ensure that they too have access to transplantation services.90 Additionally, the HMC has substantially increased deceased donation by publicizing that “brain death” is acceptable under Islam91 and by having prominent persons, such as members of the royal family, not only recognize the generosity of living donors and the families of deceased donors but also enroll in the organ-donor registry.92 A central component of the new Qatari program is the Doha Donation Accord,93 which was formulated in November 2009 with assistance from the leaders of the DICG and the International Society for Organ Transplantation, and which came into effect in 2010 following approval by the country’s Supreme Council of Health. The accord aimed to combat organ commercialism, to create a deceased-donor program in which everyone—whether citizen or foreign worker—would participate as both a potential donor and potential recipient, and to provide a path to self-sufficiency in organ transplantation.94 The original accord departed from practices elsewhere in the region by not offering any financial payment to the families of donors,95 but several of its promises—in particular, that a their family member would be offered a free airplane ticket to accompany the deceased’s body from Qatar “at the time of donation”—do not align with Guiding Principle 5 of the WHO Guiding Principles, which states that “[c]ells, tissues and organs should only be donated freely, without any monetary payment or other reward of monetary value.”96 To the accord’s framers, it would have been inconsistent with cultural norms of reciprocal gift-giving not to provide something of value to those who agree to donate organs for transplantation. To outsiders, however, such a provision seemed to exploit the vulnerable situation of the families of Qatar’s manual laborers and domestic workers from India, Nepal, the Philippines, and other developing countries, who would otherwise find it difficult to repatriate their loved one’s remains.97 At a meeting in Doha in April 2013, held to mark the fifth anniversary of the Declaration of Istanbul, the leaders of the HMC transplant program acknowledged the remaining shortcomings in the Doha Donation Accord and pledged to make revisions satisfactory to the DICG.98 In particular, they pledged to ensure that any benefits provided to donors’ families would be offered to the families of all potential donors, irrespective of whether they agree to donate their deceased relative’s organs for transplantation; further, [A] social welfare program at HMC, in association with Qatar charities, provides assistance where required to patients and their families. This assists in securing longterm medical care, supply of medications, and financial support during residency in Qatar and sometimes following the return home of expatriates. For example, following a formal socioeconomic evaluation, social services provide support to eligible families of all patients who die within HMC hospitals, including families resident abroad. [W]hile the team at the Organ Donation Centre may directly refer families of critically ill patients to welfare services for assistance as part of their routine care, such referrals and provision of welfare benefits are unrelated to donation decisions—a point that is made clear to families.99 The forces at play in the movement of Qatar toward a more self-sufficient program of organ transplantation are the same as those that have operated in the other countries described. In the countries that have provided transplants to large numbers of transplant tourists, the forces favoring payments to living donors have largely been controlled by those who directly profit from this business. But in Qatar, as in other countries that have sent most of their potential kidney and liver recipients abroad for transplantation, those who had supported transplant tourism shifted toward favoring payments to donors in Qatar, because they do not believe a domestic transplant program can be built without such financial rewards.100 In a setting like Qatar where the population is sharply divided in both socioeconomic and ethnic terms, as well as by residents’ degree of integration in, and identification with, the country and its institutions, it is particularly easy to understand the view that those who are disadvantaged and disenfranchised will only respond to a request for assistance—in the form of a life-saving organ—when it is accompanied by an offer to improve their condition materially. Nevertheless, the forces on the other side have been successful—as they have been in Pakistan and the Philippines—in finding ways of overcoming the barriers to voluntary donation that do not link benefits to an agreement to donate.101 In all these settings, the local medical and human rights advocates opposed to giving material rewards for organ donation have been inspired by professional and intergovernmental statements of principle and have derived strength from the medical leaders and WHO officials who have assisted them in persuading their governments to align national laws and practices with international norms. IV BENEFITS, COSTS, AND INTERCONNECTIONS National patterns of organ donation can be expected to be less diverse in the future, thanks to changes of the sort detailed above, as countries move away from their former roles as buyers or sellers in what has been called “the global traffic in human organs.”102 But progress toward a world in which all countries where organ transplants are performed103 rely on deceased and living-related donors, rather than paying living donors and the families of cadaver donors, has been halting, and the outcome is far from assured. To a large extent, the changes that rest on the consistent practice of noncommercial organ donation in the United States, have occurred have been heavily influenced by the WHO Guiding Principles and the Declaration of Istanbul, which, in turn, Canada, and Western Europe for more than four decades. The hands-on advocacy of WHO and DICG leaders has conveyed this vision to the responsible authorities in countries that have previously relied on paid organ vendors, and it has reinforced the efforts of local medical leaders to reform national laws and practices. But if systems that have so long embodied the ideal of voluntary, altruistic solidarity as their basis for organ donation and that have thereby attained the highest rates of donation were to move to a “regulated market” with financial inducements for donation, the progress achieved in countries that have only recently come into line with, or that have been moving in the direction of, the WHO Guiding Principles and the Declaration of Istanbul would reverse course in short order. The proponents of paying for organs in those countries— whether they be surgeons and brokers who stand to profit from transplant tourists or those who believe it is necessary to offer material expressions of gratitude in order to build a functioning organ-transplant system104—would seize upon the change of policy in the West and say, “Clearly, no principle is offended by the sale and purchase of organs, for these enlightened countries allow it; and if these countries, which are rich and medically well equipped, find payment necessary to generate an adequate supply of organs, how can we succeed in any way other than by following their example?” Legal sales cause widespread suffering, economic ruin and structural violence Moniruzzaman, 14 - Department of Anthropology and Center for Ethics and Humanities in Life Sciences, Michigan State University (Monir, “Regulated Organ Market: Reality Versus Rhetoric” October, Volume 14, Number 10, 2014) To make matters worse, selling an organ does not alleviate the sellers’ poverty. In my study, 81% of organ sellers did not receive the payment they were promised. For example, Koliza, a liver seller, received 150,000 Taka (US$1,875), only half the amount the broker had promised him. Proponents of the organ market therefore argue that a regulated system could offer full payment for the sellers (though the Iranian regulated market proves otherwise; Zargooshi 2001), yet these proponents fail to explain how the payment (if it is paid in full) ensures income-generating opportunities for impoverished populations. Here, Koplin aptly argues that an organ market could not compensate for the extensive harms and ensure long-term benefits for vendors’ overall well-being. My research cultivates Koplin’s claim by capturing that Bangladeshi sellers mostly used their money to pay off their microloans; buy material goods, such as a cell phone, a television, or gold jewelry; or arrange a dowry or medical treatment for their family. Once the money had nearly run out, most sellers had already lost their jobs. Some managed to get new jobs, but their damaged bodies impeded their abilities to continue to do physically demanding jobs, such as rickshaw pulling, manual farm work, or day laboring. As Koliza summarizes, by selling a kidney, a person damages not only himself, but also his family, noting that “three of my family members were depending on my income, and now I am done, and so are they.” As a result, some sellers have turned to organ brokering; they prey on their families, neighbors, and villagers just to get by. My research also finds that many sellers entered the organ market to pay off their debts, but soon were back in debt (see Cohen 2003). For example, Koliza took out new microcredit loans to start a poultry farm a year after selling his liver lobe. With a chicken mortality rate as high as 50%, at the return of his microcredit debt Koliza remarked, “I no longer have other parts to spare.” A regulated organ market could not ensure the long-term economic benefits of organ sellers, but rather might corrupt the overall situation. My recent fieldwork reveals that moneylenders have pressured the poor to sell their spare organs to repay loans. Husbands have tricked or forced their wives to sell their organs for economic gain (in one case, a man married twice to profit from the sale of his wives’ kidneys, and in another case, a man sold his wife’s kidney after claiming to take her to the hospital for an appendectomy). A 6-year-old boy was murdered by an organ trafficking racket and his body tossed in a pond after both kidneys were removed (The Daily Star 2014). I also document that four members of one family (a father, two brothers, and a daughter-in-law) each sold a kidney. Buyers regularly publish organ classifieds in major newspapers for soliciting organs, and brokers have expanded their networks from local to national to international levels. Such profound violence, exploitation, and suffering would be rife in the regulated or rampant commerce of organs. In sum, after selling their vital organs, the health of sellers is compromised, their economic situation has worsened, and their social status has declined (Moniruzzaman 2012). The outcomes of organ selling are invasive, harmful, and devastating . As seller Koliza said with regret, “I donated my liver lobe to: i) live better, ii) save a life, and iii) satisfy God. In the end, my recipient died after a month and I could not escape the clutches of poverty. If I had a second chance in life, I would not sell my body parts, nor let others die inside out from it.” It can therefore be argued that a regulated organ market is not the solution, but rather, the strict criminalization of the organ trade is ethically and pragmatically essential. As Koplin notes, a regulated organ market would improve vendors’ well-being or minimize their harms lack evidential warrant. Such a system does not speak to the lives of the economic underclass, but rather seriously discriminates against them. It promotes the value of individual autonomy, but puts minimal emphasis on beneficence and justice to organ sellers. We ought to oppose the organ market in order to curb this illicit practice. Independently allowing sales wrecks trust in the medical community internationally Budiani-Saberi, 9 - Dr. Budiani-Saberi is the Executive Director of the Coalition for OrganFailure Solutions (COFS). She is a medical anthropologist and has conducted extensive research on organ trafficking, including longitudinal follow-up studies and outreach on commercial living organ donors, assessing health, economic, social and psychological consequences (Debra, “Advancing Organ Donation Without Commercialization: Maintaining the Integrity of the National Organ Transplant Act” https://www.acslaw.org/publications/issue-briefs/advancingorgan-donation-without-commercialization-maintaining-the-integ-0) Material incentives for organ donation have been tested in many countries, both in regulated and unregulated, or “black,” organ markets. These organ markets consistently lead to violations of human rights, and present ethical, social, strategic and economic problems. Material incentives inevitably take unfair advantage of the poor and vulnerable who would otherwise not consider resorting to a commercial living organ donation. Employing material inducement to procure organs from a certain segment of a population may also damage society's trust in medicine and transplantation and simultaneously undermine efforts to secure and enhance altruistic donation. International opposition to commercial donation has emerged as a response to the negative experiences of many organ donors who have sold their organs. The proposal to lift the ban on the sale of organs in the United States and permit Americans to sell their organs would undermine international efforts to end such practices. deviation from this commitment in the United States also would have disastrous effects abroad, likely inducing more countries to open legal and possibly unregulated markets of their own. NOTA and its prohibition on commercial organ donation should be preserved and proposals to Moreover, any open an American market should not be pursued. There is significant potential in alternative methods to enhance altruistic and deceased donation that should be advanced without allowing the sale of organs in the United States. Key to check pandemics Michael Siegrist 14, professor at ETH Zurich, Switzerland and Alexandra Zingg, chair of the research group on Consumer Behavior and postdoctoral researcher at ETH Zurich working on a EU project, The Role of Public Trust During Pandemics: Implications for Crisis Communication European Psychologist Issue: Volume 19(1), 2014, p 23–32 Severe acute respiratory syndrome (SARS), avian influenza, and recently the H1N1 pandemic illustrate the recurrent topicality of pandemics. Human behavior strongly influences the transmission of these diseases. Therefore, public compliance with health authorities' recommendations is a key feature of successful risk management when there is a risk of highly contagious diseases. Trust has repeatedly been identified as a key factor in public compliance during a pandemic (Condon & Sinha, 2010; Liao, Cowling, Lam, Ng, & Fielding, 2010; Podlesek, Roskar, & Komidar, 2011; Prati, Pietrantoni, & Zani, 2011b) and in successfully managing risk (Slovic, 1999). The situation is complex, because trust not only affects the success of a risk management strategy, but the chosen strategy may also influence public trust and acceptance of future risk management strategies. Researchers have suggested that risk management and public health authorities' communications during past pandemics or past expected pandemics may have undermined public trust (Feufel, Antes, & Gigerenzer, 2010). The already limited effectiveness of risk communication efforts may, therefore, be even lower in the future due to a lack of trust. In our increasingly complex world, making good decisions can be difficult, and laypeople face more information than they can process. Trust is one way of reducing the complexity people encounter in modern society (Luhmann, 1989). Researchers have shown that trust is most important in situations in which people lack the knowledge needed to make a decision (Siegrist & Cvetkovich, 2000). Instead of using their own knowledge, they rely on others when making a decision. Trust can be an important cue for selecting the persons or organizations people depend on to make decisions. In risk management, trust is therefore an important factor (Siegrist, Earle, & Gutscher, 2007). One goal of risk management is using risk communication to correct possible distortions in people's risk perceptions (Lichtenstein, Slovic, Fischhoff, Layman, & Combs, 1978), because perceived risks can influence people's behavior. Many studies have examined the impact of trust on risk perception and behavior (Earle, 2010; Earle, Siegrist, & Gutscher, 2007). Results of these studies provide insights into the antecedents and consequences of trust. However, many studies are atheoretical, and the lack of a common framework for trust and its antecedents has hindered progress in the field. This lack of theory is not a new insight but has been emphasized before (Earle et al., 2007). In the present review, we try to shed light on the trust labyrinth by focusing on the most promising research approaches related to public trust and risk management. Furthermore, we take the empirical literature examining the impact of trust on behavior in pandemics into account. We searched the abstract and title fields in the Web of Science using the key words “pandemic and trust and (behavior or risk communication or risk management).” Papers were selected when they were written in English, the general population was examined, and the study reported quantitative results. Using the snowball system, we included additional papers. Based on the reviewed literature, we formulate recommendations for improving the management of the next pandemic. We also identify research gaps to address in future research. The Importance of Trust If trust is a mechanism for reducing complexity (Luhmann, 1989), then trust should be important in some decision situations but not as important in other decision situations. A recent review identified more than 130 articles that examined the consequences or antecedents of trust in a risk management context (Earle, 2010). This review clearly showed that the size and sign of the relation between trust and risk perception or risk acceptability vary widely across contexts. This finding is in line with an earlier review that suggested that the relation between trust and risk perception (as well as cooperation) is contingent upon hazard knowledge and issue importance (Earle et al., 2007). Trust is most important in situations in which individuals lack knowledge to make decisions (Siegrist & Cvetkovich, 2000). Results of this study suggest that if people lack knowledge, they do not directly assess the risks and benefits associated with a hazard but rely on trust to assess risks and benefits associated with a technology or activity . In the case of vaccination, misconceptions (i.e., inaccurate knowledge) and knowledge gaps seem to be prevalent. Results of a Swiss survey that measured the general population's knowledge of vaccination showed that many respondents answered “do not know” to many questions (Zingg & Siegrist, 2012). Moreover, the general population not only had limited knowledge but also held many misconceptions about the vaccination. Thus, most laypeople found studies on the benefits of vaccinations or important concepts such as herd immunity difficult to understand. People with little subjective knowledge (i.e., low level of knowledge and low level of strongly held misconceptions) rely on experts to evaluate various measures against pandemics, as has been shown occurred people have to decide whom to believe, and they use trust or other simple heuristics to select information sources about prevention behaviors to rely on in pandemics. Various strategies can be used to limit the outbreak of a pandemic. All of these strategies, such as proper handwashing or uptake of a vaccination, aim to change human behavior. However, for the recommended behavior to be highly effective, many people need to adopt it. Results of surveys conducted in Germany during the 2009/10 H1N1 influenza pandemic show that the during the SARS epidemic (Deurenberg-Yap et al., 2005). There is rarely consensus among experts, however. As a result, vaccine uptake remained low (Walter et al., 2011), even though the vaccine was highly effective (Wichmann et al., 2010). Fear of adverse effects of the vaccine and the perception that the vaccines were not sufficiently tested were important reasons for people deciding not to be vaccinated (Walter, Bohmer, Reiter, Krause, & Wichmann, 2012). These reasons are related to a lack of trust in the industry to produce safe and reliable vaccines and in government bodies to protect the public from harm. Trust was shown to be a key factor in public compliance with recommendations for the H1N1 influenza pandemic (Prati, Pietrantoni, & Zani, 2011a). The Italian study results showed that people who trusted the media and health ministry were more likely to adopt the recommended behaviors compared with people who did not trust the media and health ministry . Even participants who thought that the media had exaggerated the risks and that the health ministry was not doing a good job of dealing with the hazard were more likely to perform the recommended behaviors if the participants trusted the media and the health ministry. Based on these findings, the authors concluded that building trust before a pandemic is important. However, another Italian study showed that general practitioners and pediatricians were perceived as the most reliable source of information about the influenza pandemic (Ferrante et al., 2011). If the advice given by general practitioners differs from the advice given by government agencies, people will most likely do what their general practitioners recommend, even if the level of trust in government agencies is high. Trust in government was also positively related to the intention to get vaccinated in a study examining the H1N1 pandemic in the Netherlands (van der Weerd, Timmermans, Beaujean, Oudhoff, & van Steenbergen, 2011). This study also showed that trust in the government decreased during the pandemic. The level of trust was still rather high, though. In the beginning of the outbreak (April–May), the reason most reported for not trusting government information was the perception that the information was incomplete, kept secret, or withheld. In the later periods (June–August and August–November), the majority believed that the situation had been exaggerated. Likewise, trust in the US government was positively correlated with the US public's willingness to get vaccinated during the 2009 H1N1 pandemic (Quinn, Kumar, Freimuth, Kidwell, & Musa, 2009). A study conducted in Switzerland found that trust in medical organizations had a positive impact on vaccination behavior during the 2009 H1N1 pandemic (Gilles et al., 2011). In sum, studies conducted in various countries and using various trust measures produced similar findings, suggesting that trust had a positive impact on adopting precautionary behavior during a pandemic. For laypeople, trust seems to be an important factor. Results of a systematic review suggest, however, that healthcare workers' trust also has an impact on pandemic influenza vaccination behavior (Prematunge et al., 2012). Healthcare workers who did not have confidence in the World Health Organization (WHO) and who believed that the impact of H1N1 was exaggerated were less likely to get vaccinated compared with healthcare workers who had confidence in WHO (Alkuwari, Aziz, Nazzal, & A-Nuaimi, 2011). Studies examining the H5N1 influenza (2006) and the H1N1 influenza (2009) found trust in government or media news was positively associated with perceived hygiene effectiveness, which was positively associated with personal hygiene practices to protect against influenza (Liao, Cowling, Lam, & Fielding, 2011). In sum, the findings of the reviewed studies suggest that (preventive) behavior is strongly influenced by trust in authorities. Studies in various countries showed that people who trusted the authorities were more likely to adopt recommended behavior such as getting vaccines compared with people who did not trust the authorities . Extinction David Quammen 12, award-winning science writer, long-time columnist for Outside magazine for fifteen years, with work in National Geographic, Harper's, Rolling Stone, the New York Times Book Review and other periodicals, 9/29, “Could the next big animal-to-human disease wipe us out?,” The Guardian, pg. 29, Lexis Infectious disease is all around us under ordinary conditions it's natural But conditions aren't always ordinary Aberrations occur zoonosis It's a word destined for heavy use in the 21st century . It's one of the basic processes that ecologists study, along with predation and competition. Predators are big beasts that eat their prey from outside. Pathogens (disease- causing agents, such as viruses) are small beasts that eat their prey from within. Although infectious disease can seem grisly and dreadful, do to wildebeests and zebras. behaviour - to kill a cow instead of a wildebeest, or a human instead of a zebra - so a pathogen can shift to a new target. infectious presence, sometimes causing illness or death, the result is a Sars, emerging diseases in general, and the threat of a global pandemic. , every bit as as what lions . Just as predators have their accustomed prey, so do pathogens. And just as a lion might occasionally depart from its normal . When a pathogen leaps from an animal into a person, and succeeds in establishing itself as an . It's a mildly technical term, zoonosis, unfamiliar to most people, but it helps clarify the biological complexities behind the ominous headlines about swine flu, bird flu, of the future, . Ebola and Marburg are zoonoses. So is bubonic plague. So was the so-called Spanish influenza of 1918-1919, which had its source in a wild aquatic bird and emerged to kill as many as 50 million people. All of the human influenzas are zoonoses. As are monkeypox, bovine tuberculosis, Lyme disease, West Nile fever, rabies and a strange new affliction called Nipah encephalitis, which has killed pigs and pig farmers in Malaysia. Each of these zoonoses reflects the action of crossing into people from other animals a pathogen can "spillover that ", . Aids is a disease of zoonotic origin caused by a virus that, having reached humans through a few accidental events in western and central Africa, now passes human-to-human. This form of interspecies leap is not rare; about 60% of all human infectious diseases currently known either cross routinely or have recently crossed between other animals and us. Some of those - notably rabies - are familiar, widespread and still horrendously lethal, killing humans by the thousands despite centuries of efforts at coping with their effects. Others are new and inexplicably sporadic, claiming a few victims or a few hundred, and then disappearing for years. pathogens can hide . The least conspicuous strategy is to lurk within what's called a reservoir host Zoonotic : a living organism that carries the pathogen while suffering little or no illness. When a disease seems to disappear between outbreaks, it's often still lingering nearby, within some reservoir host. A rodent? A bird? A butterfly? A bat? To reside undetected is probably easiest wherever biological diversity is high and the ecosystem is relatively undisturbed. The converse is also true: ecological disturbance causes diseases to emerge. Shake a tree and things fall out. Michelle Barnes is an energetic, late 40s-ish woman, an avid rock climber and cyclist. Her auburn hair, she told me cheerily, came from a bottle. It approximates the original colour, but the original is gone. In 2008, her hair started falling out; the rest went grey "pretty much overnight". This was among the lesser effects of a mystery illness that had nearly killed her during January that year, just after she'd returned from Uganda. Her story paralleled the one Jaap Taal had told me about Astrid, with several key differences - the main one being that Michelle Barnes was still alive. Michelle and her husband, Rick Taylor, had wanted to see mountain gorillas, too. Their guide had taken them through Maramagambo Forest and into Python Cave. They, too, had to clamber across those slippery boulders. As a rock climber, Barnes said, she tends to be very conscious of where she places her hands. No, she didn't touch any guano. No, she was not bumped by a bat. By late afternoon they were back, watching the sunset. It was Christmas evening 2007. They arrived home on New Year's Day. On 4 January, Barnes woke up feeling as if someone had driven a needle into her skull. She was achy all over, feverish. "And then, as the day went on, I started developing a rash across my stomach." The rash spread. "Over the next 48 hours, I just went down really fast." By the time Barnes turned up at a hospital in suburban Denver, she was dehydrated; her white blood count was imperceptible; her kidneys and liver had begun shutting down. An infectious disease specialist, Dr Norman K Fujita, arranged for her to be tested for a range of infections that might be contracted in Africa. All came back negative, including the test for Marburg. Gradually her body regained strength and her organs began to recover. After 12 days, she left hospital, still weak and anaemic, still undiagnosed. In March she saw Fujita on a follow-up visit and he had her serum tested again for Marburg. Again, negative. Three more months passed, and Barnes, now grey-haired, lacking her old energy, suffering abdominal pain, unable to focus, got an email from a journalist she and Taylor had met on the Uganda trip, who had just seen a news article. In the Netherlands, a woman had died of Marburg after a Ugandan holiday during which she had visited a cave full of bats. Barnes spent the next 24 hours Googling every article on the case she could find. Early the following Monday morning, she was back at Dr Fujita's door. He agreed to test her a third time for Marburg. This time a lab technician crosschecked the third sample, and then the first sample. The new results went to Fujita, who called Barnes: "You're now an honorary infectious disease doctor. You've self-diagnosed, and the Marburg test came back positive." The Marburg virus had reappeared in Uganda in 2007. It was a small outbreak, affecting four miners, one of whom died, working at a site called Kitaka Cave. But Joosten's death, and Barnes's diagnosis, implied a change in the potential scope of the situation. That local Ugandans were dying of Marburg was a severe concern - sufficient to bring a response team of scientists in haste. But if tourists, too, were involved, tripping in and out of some python-infested Marburg repository, unprotected, and then boarding their return flights to other continents, the place was not just a peril for Ugandan miners and their families. It was also an international threat. The first team of scientists had collected about 800 bats from Kitaka Cave for dissecting and sampling, and marked and released more than 1,000, using beaded collars coded with a number. That team, including scientist Brian Amman, had found live Marburg virus in five bats. Entering Python Cave after Joosten's death, another team of scientists, again including Amman, came across one of the beaded collars they had placed on captured bats three months earlier and 30 miles away. "It confirmed my suspicions that these bats are moving," Amman said - and moving not only through the forest but from one roosting site to another. Travel of individual bats between far-flung roosts implied circumstances whereby Marburg virus might ultimately be transmitted all across Africa, from one bat encampment to another. It voided the comforting assumption that this virus is strictly localised. And it highlighted the complementary question: why don't outbreaks of Marburg virus disease happen more often? Marburg is only one instance to which that question applies. Why not more Ebola? Why not more Sars? In the case of have been very much worse Sars , the scenario could . Apart from the 2003 outbreak and the aftershock cases in early 2004, it hasn't recurred. . . so far. Eight thousand cases are relatively few for such an explosive infection; 774 people died, not 7 million. Several factors contributed to limiting the scope and impact of the outbreak, of which humanity's good luck was only one. Another was the speed and excellence of the laboratory diagnostics - finding the virus and identifying it. Still another was the If the virus had arrived in a it might have burned through a much larger brisk efficiency with which cases were isolated, contacts were traced and quarantine measures were instituted, first in southern China, then in Hong Kong, Singapore, Hanoi and Toronto. different city segment of humanity sort of big - more loosely governed, full of poor people, lacking first-rate medical institutions - . One further factor, possibly the most crucial, was inherent in the way Sars affects the human body: symptoms tend to appear in a person before, rather than after, that person becomes highly infectious. That allowed many Sars cases to be recognised, hospitalised and placed in isolation before they hit their peak of infectivity. With influenza and many other diseases, the order is reversed. That probably helped account for the scale of worldwide misery and death during 1918 influenza occurred before globalisation the Next Big One comes it will conform to the 1918 influenza high infectivity preceding notable symptoms it move through airports like an angel of death the -1919 . And that infamous global pandemic , in the era likely . Everything nowadays moves around the planet faster, including viruses. same perverse pattern as the . That will help When : cities and . The Next Big One is a subject not every virus goes airborne If HIV could you and I might already be dead If rabies could would be the most horrific pathogen on the planet The influenzas are well adapted for airborne transmission Human-to-human transmission is the crux That is what separates a localised disease from a global pandemic that disease scientists around the world often address. The most recent big one is Aids, of which the eventual total bigness cannot even be predicted - about 30 million deaths, 34 million living people infected, and with no end in sight. Fortunately, from one host to another. -1 , . , it the virus . , which is why a new strain can circle the world within days. The Sars virus travels this route, too, or anyway by the respiratory droplets of sneezes and coughs - hanging in the air of a hotel corridor, moving through the cabin of an aeroplane - and that capacity, combined with its case fatality rate of almost 10%, is what made it so scary in 2003 to the people who understood it best. . capacity bizarre, awful, , intermittent and mysterious (such as Ebola) . Have you noticed the persistent, low-level buzz about avian influenza, the strain known as H5N1, among disease experts over the past 15 years? That's because avian flu worries them deeply, though it hasn't caused many human fatalities. Swine flu comes and goes periodically in the human population (as it came and went during 2009), sometimes causing a bad pandemic and sometimes (as in 2009) not so bad as expected; but avian flu resides in a different category of menacing possibility. It worries the flu scientists because they know that H5N1 influenza is extremely virulent in people, with a high lethality. As yet, there have been a relatively low number of cases, and it is poorly transmissible, so far, from human to human. It'll kill you if you catch it, very likely, but you're unlikely to catch it except by butchering an infected chicken. But if H5N1 mutates or reassembles itself in just the right way, if it adapts for human-to-human transmission, it could become the biggest and fastest killer disease since 1918. It got to Egypt in 2006 and has been especially problematic for that country. As of August 2011, there were 151 confirmed cases, of which 52 were fatal. That represents more than a quarter of all the world's known human cases of bird flu since H5N1 emerged in 1997. But here's a critical fact: those unfortunate Egyptian patients all seem to have acquired the virus directly from birds. This indicates that the virus hasn't yet found an efficient way to pass from one person to another. Two aspects of the situation are dangerous, according to biologist Robert Webster. The first is that Egypt, given its recent political upheavals, may be unable to staunch an outbreak of transmissible avian flu, if one occurs. His second concern is shared by influenza researchers and public health officials around the globe: As long as H5N1 is out there in there is the possibility of disaster No other primate has ever weighed upon the planet to anything like the degree we do We are an outbreak And here's the thing about outbreaks they end with all that mutating, with all that contact between people and their infected birds, the virus could hit upon a genetic configuration making it highly transmissible among people. " the world ," Webster told me, " . . . There is the theoretical possibility that it can acquire the ability to transmit human-to-human." He paused. "And then God help us." We're unique in the history of mammals. . In ecological terms, we are almost paradoxical: large-bodied and long-lived but grotesquely abundant. : . . In some cases they end after many years, in others they end rather soon. In some cases they end gradually, in others they end with a crash. In certain cases, they end and recur and end again. Populations of tent caterpillars, for example, seem to rise steeply and fall sharply on a cycle of anywhere from five to 11 years. The crash endings are dramatic, and for a long while they seemed mysterious. What could account for such sudden and recurrent collapses? One possible factor is infectious disease, and viruses in particular. 1NC SHORTAGES Util Greene 2010 – Associate Professor of the Social Sciences Department of Psychology Harvard University (Joshua, Moral Psychology: Historical and Contemporary Readings, “The Secret Joke of Kant’s Soul”, www.fed.cuhk.edu.hk/~lchang/material/Evolutionary/Developmental/GreeneKantSoul.pdf, WEA) What turn-of-the-millennium science is telling us is that human moral judgment is not a pristine rational enterprise, that our moral judgments are driven by a hodgepodge of emotional dispositions, which themselves were shaped by a hodgepodge of evolutionary forces, both biological and cultural. Because of this, it is exceedingly unlikely that there is any rationally coherent normative moral theory that can accommodate our moral intuitions. Moreover, anyone who claims to have such a theory , or even part of one, almost certainly doesn't. Instead, what that person probably has is a moral rationalization. It seems then, that we have somehow crossed the infamous "is"-"ought" divide. How did this happen? Didn't Hume (Hume, 1978) and Moore (Moore, 1966) warn us against trying to derive an "ought" from and "is?" How did we go from descriptive scientific theories concerning moral psychology to skepticism about a whole class of normative moral theories? The answer is that we did not, as Hume and Moore anticipated, attempt to derive an "ought" from and "is." That is, our method has been inductive rather than deductive. We have inferred on the basis of the available evidence that the phenomenon of rationalist deontological philosophy is best explained as a rationalization of evolved emotional intuition (Harman, 1977). Missing the Deontological Point I suspect that rationalist deontologists will remain unmoved by the arguments presented here. Instead, I suspect, they will insist that I have simply misunderstood what Kant and like-minded deontologists are all about. Deontology, they will say, isn't about this intuition or that intuition. It's not defined by its normative differences with consequentialism. Rather, deontology is about taking humanity seriously . Above all else, it's about respect for persons. It's about treating others as fellow rational creatures rather than as mere objects, about acting for reasons rational beings can share. And so on (Korsgaard, 1996a; Korsgaard, 1996b).This is, no doubt, how many deontologists see deontology. But this insider's view, as I've suggested, may be misleading. The problem, more specifically, is that it defines deontology in terms of values that are not distinctively deontological, though they may appear to be from the inside. Consider the following analogy with religion. When one asks a religious person to explain the essence of his religion, one often gets an answer like this: "It's about love , really. It's about looking out for other people, looking beyond oneself. It's about community, being part of something larger than oneself." This sort of answer accurately captures the phenomenology of many people's religion, but it's nevertheless inadequate for distinguishing religion from other things. This is because many, if not most, non-religious people aspire to love deeply, look out for other people, avoid self-absorption, have a sense of a community, and be connected to things larger than themselves. In other words, secular humanists and atheists can assent to most of what many religious people think religion is all about. From a secular humanist's point of view, in contrast, what's distinctive about religion is its commitment to the existence of supernatural entities as well as formal religious institutions and doctrines. And they're right. These things really do distinguish religious from non-religious practices, though they may appear to be secondary to many people operating from within a religious point of view. the standard deontological/Kantian self-characterizatons fail to distinguish deontology from other approaches to ethics. (See also Kagan (Kagan, 1997, pp. 70-78.) on the difficulty of defining deontology.) It seems to me that consequentialists, as much as anyone else, have respect for persons, are against treating people as mere objects, wish to act for reasons that rational creatures can share , etc. A consequentialist respects other persons, and refrains from treating them as mere objects, by counting every person's well-being in the decision-making process. Likewise, a consequentialist attempts to act according to reasons that rational creatures can share by acting according to principles that give equal weight to everyone's interests, i.e. that are impartial. This is not to say that consequentialists and deontologists don't differ. They do. It's just that the real differences may not be what deontologists often take them In the same way, I believe that most of to be. What, then, distinguishes deontology from other kinds of moral thought? A good strategy for answering this question is to start with concrete disagreements between deontologists and others (such as consequentialists) and then work backward in search of deeper principles. This is what I've attempted to do with the trolley and footbridge If you ask a deontologically-minded person why it's wrong to push someone in front of speeding trolley in order to save five others, you will getcharacteristically deontological answers. Some will be tautological: "Because it's murder!" Others will be more sophisticated: "The ends don't justify the means." "You have to respect people's rights." But, as we know, these answers don't really explain anything, because if you give the same people (on different occasions) the trolley case or the loop case (See above), they'll make the opposite judgment , even though their initial explanation concerning the footbridge case applies equally well to cases, and other instances in which deontologists and consequentialists disagree. Talk about rights, respect for persons, and reasons we can share are natural attempts to explain, in "cognitive" terms, what we feel when we find ourselves having emotionally driven intuitions that are odds with the cold calculus of consequentialism. Although these explanations are inevitably incomplete, there seems to be "something deeply right" about them because they give voice to powerful moral emotions. But, as with many religious people's accounts of what's essential to religion, they don't really explain what's distinctive about the philosophy in question one or both of these cases. Increasing supply expands demand – the aff doesn’t solve, they just put more people on the organ waiting lists Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25) In resolving the policy implications of the conflict among ethical values, proponents of organ sales argue that the burden of persuasion falls on those who urge prohibitions or restrictions because markets would make more organs available and hence save more lives.150 The first response to such a claim is that a society that fails to develop and utilize all forms of medical interventions to extend every life does not fail its citizens, whereas one that builds life-saving efforts on practices that are destructive of other important values—of equality, dignity, and liberty—does.151 The second response—which does not depend upon taking a stance on what constitutes a good society—is that good reasons exist to doubt proponents’ claims that a market run according to acceptable ethical standards would, in the long run, produce a larger number of organs than can be achieved without financial inducements, much less put an end to the shortage in organs.152 (footnote 152) 152. The notion that the “gap” between supply and demand can ever be closed ignores the elasticity of demand. The large increase in the United States over the past twenty years in the number of people waiting for a kidney transplant reflects not only the growing incidence of kidney disease (as to which preventive efforts would be the preferable response) but also the substantial increase in the number of kidneys available for transplantation, which makes nephrologists more willing to place patients on the waiting list. Were kidneys no longer scarce, physicians would list not only those patients with less severe kidney failure but also those patients whose prospects for a good outcome are lower because of comorbidities. Beard is wrong – the plan is more likely to cause crowd-out and exacerbate shortages Capron, 14 – this evidence is responding directly to Beard who is cited in the footnotes - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25) Free-market economists are quick to pronounce that the organ transplantation policies based on the noncommercial model followed by most countries over the past three decades “have failed.”153 This seems a rather blinkered assessment of a system that has extended and improved millions of lives while also providing a dramatic affirmation of human generosity and solidarity. There is no question that more organs are needed, but were all countries to adopt the “best practices” used by the organ-procurement programs with the highest rates of donation, a huge increase in transplantation would be possible without resort to paying for organs. Indeed, during the first decade of this century, a concerted effort by the Department of Health and Human Services led to an increase of more than twenty-five percent in the rate of donation in the United States.154 Moreover, if only a small fraction of the amount that would need to be spent to purchase organs in a “regulated market” were instead used to improve the present system, further substantial increases in the rate of donation would be possible. But what of the claim that it is self-evident that paying for organs would increase the net rate of donation?155 The extensive literature on “crowding out” suggests that many people who are willing to donate in a voluntary, unpaid system would cease doing so once paid donation became an accepted practice.156 It is not simply that one does not want to be played for a fool (by giving away what others are paid for), but that the nature of the act changes when it is not experienced by the donor , and seen immediately and universally by others, as something that is generous and ennobling . This change would be especially pronounced if, as is likely to be the case, most organ vendors were understood to be acting out of financial desperation. Although today’s most highly motivated donors—those who are giving a kidney to a close relative—might be expected to be immune to such a change, this has been found not to be the case. [R]ecently, when the U.S. rules for allocating deceased donor kidneys were changed to give children on the waiting list greater access to deceased adult donors’ kidneys, parental donations fell by a larger amount, so that overall fewer pediatric kidney transplants are being done while some potential adult recipients have been deprived of a kidney that went to a child instead.157 Likewise, the ready availability of vended kidneys and liver lobes would leave most potential recipients disinclined to ask a relative or friend to donate. Who would want to ask for such a gift from a loved one when his or her need for an organ can be met without imposing any burden on that person and without enmeshing oneself in all the psychological and moral complexities that arise in “the gift relationship”?158 Summarizing observational and experimental research over many decades by economists and social psychologists, Sheila and David Rothman conclude that “although the case for the ‘hidden costs of rewards’ is certainly not indisputable, it does suggest that a market in organs might reduce altruistic donation and overall supply.”159 (Footnote 153) 153. T. RANDOLPH BEARD, DAVID L. KASERMAN & RIGMAR OSTERKAMP, THE GLOBAL ORGAN SHORTAGE: ECONOMIC CAUSES, HUMAN CONSEQUENCES, POLICY RESPONSES 1 (2013). No shortage- data is distorted Segev, 10 -- Johns Hopkins professor of surgery [Dorry, MD, PhD, and S.E. Gentry, Department of Epidemiology, Johns Hopkins School of Public Health, Department of Mathematics, United States Naval Academy, "Terminology Influences Many Aspects of the Market/Incentives Debate," American Journal of Transplantation, 2010, 10, 2375, ebsco, accessed 8-27-14] In seeking more precise terminology, we wish to clarify two other terms critical to this debate. Carefully examining the kidney waiting list reveals that the 'tremendous organ shortage' is widely distorted, with totals on the waiting list inflated by inactive candidates who are not eligible for a transplant (approximately one-third of the list). For exam- ple, between 2002 and 2007, McCullough and colleagues showed that the active kidney waiting list grew by only 10%, indicating a near steady-state of new eligible regis- trants and transplants for them, while the inactive kidney waiting list grew by 282% (2). Furthermore, live donation rates are often said to have 'stalled' since 2004. However, living donation rates tripled in the preceding 15 years (3). The level donation rates since 2004 suggest sustainability of these historic highs in donation. Some areas of living donation have seen exponential growth in the last few years. Nondirected donation grew from 2 in 1998 to 56 in 2002 to 137 in 2009 (4,5). Paired donation grew from 3 in 2000 to 39 in 2004 to 419 in 2009 (5,6). These donors do not comprise a large proportion of the living donor pool at this early stage and so do not con- tribute to a visible overall rise in kidney donation. As they continue to increase, however, these sources of donors will likely play a more obvious role in the future. In fact, the rise in living donation between 2008 and 2009 is partly attributable to these novel modalities. Squo solves— A subpoint: 3-D printing Gilpin, 14 -- TechRepublic staff writer, citing Dr. Jay Hoying, the Division Chief of Cardiovascular Therapeutics at the Cardiovascular Innovation Institute at Louisville [Lyndsey, "New 3D bioprinter to reproduce human organs, change the face of healthcare," Tech Republic, 8-1-14, www.techrepublic.com/article/new-3d-bioprinter-to-reproduce-humanorgans/, accessed 8-28-14] New 3D bioprinter to reproduce human organs, change the face of healthcare Researchers are only steps away from bioprinting tissues and organs to solve a myriad of injuries and illnesses. TechRepublic has the inside story of the new product accelerating the process. If you want to understand how close the medical community is to a quantum leap forward in 3D bioprinting, then you need to look at the work that one intern is doing this summer at the University of Louisville. A team of doctors, researchers, technicians, and students at the Cardiovascular Innovation Institute (CII) on Muhammad Ali Boulevard in Louisville, Kentucky swarm around the BioAssembly Tool (BAT), a square black machine that's solid on the bottom and encased in glass on three sides on the top. There's a large stuffed animal bat sitting on the machine and a computer monitor on the side, showing magnified images of the biomaterial that the machine is printing. This team stands at the forefront of research in 3D bioprinting, as they methodically take steps toward printing a working human heart. As part of this work, the team is also pioneering breakthroughs in printing human stem cells -- a move that could remove the raging ethical dilemmas associated with stem cells and potentially take regenerative medicine to new heights. The combination of these stem cells and 3D bioprinting is going to help repair or replace damaged human organs and tissues, improve surgeries, and ultimately give patients far better outcomes in dealing with a wide range of illnesses and injuries. But, there are problems with BAT -- as advanced as it is from its surprising background as a military project. It's way too slow and printing anything with it is a tortuously manual process. The printhead runs on a three-axis robot that doesn't handle curves very well. No one at the lab knows the limitations and challenges of BAT better than a summer intern named Katie, an undergrad from Georgetown University. She's in Louisville as part of a summer program for the Howard Hughes Medical Institute that exposes students to cutting edge research and lets them participate in groundbreaking work. Katie's not sure what she wants to do when she finishes her bachelor's degree in mathematics but she has thrown herself into her work at the CII with full intensity this summer. A big part of what Katie does is build intricate scripts to tell BAT what to print. It's similar to a computer programmer writing in assembly language to give a computer system an exact set of instructions. It's an incredibly laborious process and it involves Katie going back and forth with Dr. Jay Hoying, the Division Chief of Cardiovascular Therapeutics at CII and one of the leaders of the 3D bioprinting project. "What's interesting is Katie's background in mathematics," said Hoying, "which is really essential here because it's basically a geometry problem." But Hoying and his team are about to get a new 3D bioprinting solution that will accelerate their work so significantly that what has taken Katie half the summer will soon take half a day, according to Hoying. This new solution's hardware, BioAssemblyBot (BAB), runs as a six-axis robot that is far more precise than BAT. The real difference, however, is in the software: Tissue Structure Information Modeling (TSIM), which is basically a CAD program for biology. It takes the manual coding out of the process and replaces it with something that resembles desktop image editing software. It allows the medical researchers to scan and manipulate 3D models of organs and tissues and then use those to make decisions in diagnosing patients. And then, use those same scans to model tissues (and eventually organs) to print using the BAB. " It's a big step forward in the capability and technology of bioprinting," said Hoying, "but what someone like me is really excited about is now it enables me to do so much more." Hoying went back to the example of his highly-capable intern, Katie. "Katie has spent half the summer just understanding and scripting up and doing this," he said. "Now if Katie can do that in half a day, I can do more biology, I can do more experiments. I can explore new cell combinations.... In that same half a summer I could have explored different structures, different cell-[to]-cell combinations, experiment here growing them up, etc. Where she's taking half the summer to understand the geometry, script it out, test it... with the BAB and the TSIM, I would have finished a handful of experiments." Bioprinting's new robot BAB and TSIM are an integrated package built by Advanced Solutions, a private biotech company located in suburban Louisville. The new solution officially launches today -- Friday, August 1, 2014 -- and Hoying's CII is not the only lab ready to jump on it. In fact, Hoying is concerned that demand could be so strong that it could interfere with his facility getting one as soon as he would hope, although that seems unlikely considering Hoying was an important collaborator and consultant for Advanced Solutions in creating the product. While the lab where Katie and Dr. Hoying run their experiments is downtown next to the hospitals and cutting edge medical facilities, the Advanced Solutions office is about 20 miles east, tucked away in a suburban office park that's also home to a tree care service, a construction company, a dental association, a US Postal Service branch, and a handful of small healthcare companies. The building that houses Advanced Solutions sits just down a hill off Nelson Miller Parkway, and less than 1000 feet from the I-265 interstate highway. From the outside, there's little indication that the single story brick structure houses a team of 65 people who are working on a hardware and software solution that could revolutionize modern medicine. Advanced Solutions has been around since 1987. During most of the time since then, it has been a software provider building solutions on top of Autodesk for specific industries. But, in October 2010, Advanced Solutions CEO Michael Golway took an alumni tour of the CII -since Golway is a University of Louisville alum and the university is a key partner of the facility. Golway told TechRepublic, "At the end of the presentation, Dr. Stu Williams passionately summarized the CII business model and I was not only impressed by the CII innovation, team of researchers and focus on cardiovascular solutions but intrigued by the possibilities that Advanced Solutions engineering know-how could contribute in a positive and profound way to helping his team. I followed back up with Dr. Williams one-on-one and we became fast friends." That began the journey that would lead to the integrated solution that Golway and his team devised to meet the needs of Williams, Hoying, and researchers and hospitals throughout the world. "Over the course of 2.5 years we would periodically meet and I learned about some of the technological workflow challenges that slowed his team from advancing the biology research to achieve the Total Bioficial Heart," Golway said. "Dr. Williams and eventually Dr. Hoying also invested time in learning more about the Advanced Solutions team and our capabilities. After 2.5 years of building a terrific working relationship, listening, learning and collaborating I brought forward an engineering design concept for Dr. Williams and Dr. Hoying to consider that was intended to solve the tissue design technology problem." Hoying and Williams, who is the division chief of the bioficial heart program at the CII, are both widely respected cell biologists who came to Louisville from Arizona to work together. They were obviously impressed that Golway's solution could get them closer to their goal of creating that "Total Bioficial Heart." Golway continued, "In March 2013, Advanced Solutions Life Sciences, LLC was formed as a wholly owned subsidiary of Advanced Solutions, Inc. to engineer, fabricate and commercialize the technology in support of that initial concept design. Today the BioAssemblyBot and [the] TSIM software integrated solution are the work product from that endeavor." Beyond the launch of his company's product, Golway views this work as part of a larger trend of digitizing the medical and biological space, which is destined to unleash other new advances as well. "What's been really interesting to me is that we're on a trajectory here where we're really treating biology as more of an information technology," Golway said. "That's incredibly exciting to us because IT grows exponentially -- instead of just the hardcore traditional discovery that biology has been tracking on, if we can translate that into IT we can take that experimentation and rapidly start looking at optimization. How to combine cell types in a way to create cell types and structures. The exponential curve is already there but this technology allows you to take the next step." 2NC AT: COERCION/AUTONOMY It’s not coercion or paternalism since donors are already dead Spital and Taylor, 8 – Department of Medicine, Mount Sinai School of Medicine, New York, New York (Aaron and James “In Defense of Routine Recovery of Cadaveric Organs: A Response to Walter Glannon” Cambridge Quarterly of Healthcare Ethics (2008), 17, 337–343 Glannon also claims that “[e]liminating consent would leave it entirely up to physicians to determine the extent of care appropriate for the patient. This would mean a return to absolute physician paternalism. It would also raise the question of whether the interests and needs of potential transplant recipients trumped the interests and needs of critically ill patients without organ failure” (p. 333). We fail to see why routine recovery of cadaveric organs should generate such concerns. Routine recovery would be applicable only to patients who are already dead. Furthermore, as previously noted, this plan would not interfere with the separation of critical care and organ recovery physicians . Thus routine recovery would not affect the level of care deemed appropriate for or delivered to dying patients. In addition, it would not remove the need for surrogate consent before removing life support, and it would have no effect whatsoever on other areas of medical practice. Thus, it is not true that implementation of routine recovery would lead to a “return to absolute physician paternalism” (p. 333). Glannon argues that, “[i]f we respect people’s choices about continuing or withdrawing life-sustaining care, and if agreeing to or refusing organ donation is a choice made during this time, then it would be difficult to exclude consent regarding donation from these choices” (p. 335). The implication is that if we honor one choice we must honor the other because these issues arise at almost the same time. We fail to see the logic here. There is no reason why we cannot continue to require consent for withdrawal of life-sustaining care, as we should, while at the same time eliminating the requirement for consent prior to cadaveric organ recovery. Cadavers are worm food – they lack rights Spital, 5 - Department of Medicine, Mount Sinai School of Medicine, New York, New York (Aaron, “Conscription of Cadaveric Organs for Transplantation: A Stimulating Idea Whose Time Has Not Yet Come” Cambridge Quarterly of Healthcare Ethics (2005), 14, 107–112) The major concern about conscription of cadaveric organs is that, because it eliminates the need for consent, it would be seen by some as usurping autonomy. But it does not make sense to talk about autonomy of dead people. As Jonsen points out: “consent is ethically important because it manifests and protects the moral autonomy of persons . . . [and] it is a barrier to exploitation and harm. These purposes are no longer relevant to the cadaver which has no autonomy and cannot be harmed.”2 Not everyone agrees with Jonsen. Those who disagree claim that people may have interests that survive their deaths. Glannon suggests that one example of a surviving interest is a desire for “bodily integrity after death.” 3 He and others argue that thwarting this interest, by conscripting organs from the bodies of people who had, while alive, expressed opposition to posthumous organ donation, would harm these people after their deaths. To my mind the concepts of surviving interests and especially posthumous harm are difficult ones and I have yet to be convinced of their existence. But even if they are real, they cannot possibly be as important as the interests of the living. As Harris points out: “[T]here is almost universal agreement that death is usually the worst harm that can befall a human person who wants to live. . . . [R]ights or interests would have to be extremely powerful to warrant upholding such rights or interests at the cost of the lives of others. . . . [T]he interests involved after death are simply nowhere near strong enough [to justify doing this].” 4 Furthermore, it should be remembered, but often is not, that although some people wish to remain intact after death, this is impossible—the body always decays and returns to the “biomass.” 5 The autonomy DA is terminally N/U – disproves slippery slope Spital, 7 - Department of Medicine, Mount Sinai School of Medicine, New York, New York (Aaron, “Routine Recovery of Cadaveric Organs for Transplantation: Consistent, Fair, and LifeSaving” CJASN March 2007 vol. 2 no. 2 300-303, doi: 10.2215/CJN.03260906) Routine Removal: Consistency with Other Socially Desirable but Intrusive Programs One of the major reasons for insisting on consent is to show respect for autonomy, a major principle of biomedical ethics. However, Beauchamp and Childress (12) pointed out that as important as this principle is, it “has only prima facie standing and can be overridden by competing moral considerations.” One such consideration occurs when society is so invested in attaining a certain goal that is designed to promote the public good that it mandates its citizens to behave in a manner that increases the probability of achieving that goal, even though many of them would prefer not to act in this way. Silver (13) pointed out the legitimacy of this approach in his discussion of an “organ draft”: “The sense behind the coercive power of democratic governments is to move society forward by public decree where individuals will not, by private volition, act in their own best interests.” Examples of such situations include a military draft during wartime, taxation, mandatory vaccination of children who attend public school, jury duty, and, perhaps most relevant to routine removal of cadaveric organs, mandatory autopsy when foul play is suspected. Although some people may not like the fact that they have no choice about these programs, the vast majority of us accept their existence as necessary to promote the common good. Routine removal of cadaveric organs would be consistent with this established approach, and it would save many lives at no more (and we believe much less) cost than these other mandated programs. Furthermore, had we been born into a world where cadaveric organ removal for transplantation were routine, it is likely that few if any people would question the policy, just as few of us question mandatory autopsy today. And while most of us will never need a transplant, nonrecipients would also benefit from the plan in the same way that people who never file a claim benefit from the security of having insurance. It should also be noted here that, as discussed below, a person’s autonomy is lost after death. Recovering Cadaveric Organs without Consent: Life-Saving and Fair Few would argue against the view that routine removal of usable cadaveric organs would save many lives. Under such a program, recovery of transplantable organs should approach 100%. It is unlikely that any program designed to increase consent rates could even come close. Although the expected high efficiency of routine recovery is its major raison d’être, it also has several other advantages. Routine recovery would be much simpler and cheaper to implement than proposals designed to stimulate consent because there would be no need for donor registries, no need to train requestors, no need for stringent governmental regulation, no need to consider paying for organs, and no need for permanent public education campaigns. The plan would eliminate the added stress that is experienced by some families and staff who are forced to confront the often emotionally wrenching question of consent for recovery. Delays in the removal of transplantable organs, which sometimes occur while awaiting the family’s decision and which can jeopardize organ quality, would also be eliminated. A final advantage of routine posthumous organ recovery is that it is more equitable than are systems that require consent. All people would be potential contributors, and all would be potential beneficiaries. No longer could one say, “Thank you,” when offered an organ but say, “No,” when asked to give one; such “free riders” would be eliminated. And concern about exploitation of the poor, as sometimes arises during discussions of organ sales, is not an issue here. Conscription is morally necessary – only the rights of potential recipients are at stake – allowing donor consent is unethical Emson, 3 – Professor and Head, Department of Pathology, College of Medicine, University of Saskatchewan (H.E., “It is immoral to require consent for cadaver organ donation” J Med Ethics 2003;29:125-127 doi:10.1136/jme.29.3.125) In my opinion the human cadaver, at the point at which life departs, should become a resource for those who may benefit from donation of its organs. Our society has conspicuously failed to achieve this by voluntary means, and the increasing length of the queues for donated organs testifies eloquently to this failure. On the other hand, a majority of the community express their belief that cadaver organs should be used for transplantation. Faced with this contradiction and the dilemma so caused, it appears to be morally and practically necessary for society to act to overcome this failure, and this could best be done by making the human cadaver the charge and responsibility of the state, to determine its best disposition. Without going into detail, it might be done by establishing an organisation for this purpose, under the authority of the state but at “arm’s length”, very strictly separated from government and politics. The rights and responsibilities of disposal of the cadaver should be vested in this organisation. When the cadaver has been used, if possible, as a source of transplantable organs it may, if the family wishes, be reconsigned to their care, for such religious and social observances as they desire. Practically, this might be welcomed by many, as removing the necessity for an agonising decision by the family. Also practically, it is impossible for the family, in such circumstances, to be able to tell what has been done; after routine autopsy the body is reconstituted so that there is no outward sign, to ordinary observation such as that at an open coffin funeral or memorial service, that any examination has been performed. Legally, this might be regarded as an extension of the doctrine of Parens patriae, the assumption by the state of parental responsibility when this is necessary, on behalf of the persons benefiting from organ donation and transplantation. Morally, I regard the rights of the potential recipient, because of the benefits accruing, to be pre-emptive over all others. In this situation, the idea of consent and its corollary, refusal are not morally applicable. One may be able to give or refuse consent to a procedure which affects oneself, but organ donation affects no one physically; no human person is involved as donor. To grant the right and power of consent to an individual who may be affected emotionally, is to elevate the possible emotional affect of one person, as more important than the physical life of another . The imbalance of benefit is too great to permit of this, and I find it morally unacceptable. To require consent for cadaver organ donation from the one of whose person in life the body is a part, is unacceptably to extend control of that body beyond legitimate limits. To require consent from the relatives of a previously living person is unacceptably to extend their control over matters where the good of others should be the predominant concern. The concept of consent in this situation is morally incorrect. 2NC SOLVES ORGANS The CP obviously solves better than the aff – they create a market where some people – mostly poor people – decide to sell organs for profit. The CP requires all people to give up their organs upon brain death – regardless of consent. 1nc Spital evidence says it creates 100% compliance, except for religious objections. More than enough can come from cadavers – live donation is unnecessary Carney, 7 - Scott Carney is an investigative journalist based in Chennai, India (“The Case for Mandatory Organ Donation” Wired, 5/8, http://archive.wired.com/medtech/health/news/2007/05/india_transplants_donorpolicy Increasing the supply of cadaver organs is an obvious solution, but volunteer programs have not produced enough organs to make a difference. Now some leading ethicists and doctors are reexamining the principle of informed consent in government organ-donor programs, arguing that harvesting from cadavers should be a routine procedure just like autopsies in murder investigations. "Routine recovery would be much simpler and cheaper to implement than proposals designed to stimulate consent because there would be no need for donor registries, no need to train requestors, no need for stringent government regulation, no need to consider paying for organs, and no need for permanent public education campaigns," wrote Aaron Spital, a clinical professor at Mount Sinai School of Medicine, and James Stacey Taylor, an assistant professor of philosophy at the College of New Jersey, in a controversial article published this year by the American Society of Nephrology. This approach faces obvious and enormous obstacles, challenging as it does widely and deeply held beliefs about the sanctity of the body, even in death. But it could be the only solution that works. Roughly half a million people around the world suffer from kidney failure and many are willing to pay any price for a donor organ. They have two options: wait on impossibly long donation lists or pay someone for a live donor transplant. The United Network for Organ Sharing, which runs the current system of cadaver donation in the United States, maintains lists of brain-dead patients around the country and actively tries to match up prospective donors. At present there are more than 90,000 people waiting for kidneys but only about 14,000 donors enter the system each year. The shortage of donors isn't based on a shortage of brain-dead people in hospitals , but on the shortage of people whose organs -- even after they have opted into a convoluted and difficult organ-donation program -- never find their way to a viable patient. A 2005 Gallup poll revealed that more than half the population of the United States was willing to donate organs after death, but inefficiencies in the current system mean that even willing donors often end up not donating because families raise objections or there is a question about consent. Fewer than two out of 10 families opt to donate organs of relatives after death. Hospitals often are unwilling to share organs from donors on their rolls and waste organs while waiting to set up their own in-house transplants. Often, perfectly good transplant organs get lost in a bureaucratic shuffle. Routine organ donations would dramatically increase the supply of donor organs; with a little effort it would be possible to set up a system to transport donation-worthy organs anywhere in the world. The CP increases supply comparatively better than sales – it makes the aff moot Silver, 88 – Assistant Professor of Law, Touro College, Jacob D. Fuchsberg Law Center. (Theodore, “The Case for a Post-Mortem Organ Draft and a Proposed Model Organ Draft Act” 68 B. U. L. Rev. 681 (1988) An organ draft eliminates all of the price-based uncertainty that attends the market system. Subject only to religious exemption, it will make all usable post-mortem organs available for transplant. Moreover, if the availability of sellers' organs will reduce the need for live donation and improved immunologic matching, then the availability of drafted organs will do so more effectively. Proponents further contended that an organ market operated pursuant to statute might foster positive change in social attitudes toward donation. 102 If an organ market will improve the public's attitude toward donation, an organ draft will foster even greater and more dramatic improvement. 10 3 Proponents of an organ market anticipated certain objections it would likely raise.1 4 These included the likelihood that a market system would reduce the rate of organ donation 105 and that sale is in itself immoral or unethical.1 06 Professor Brams argued that a decrease in the supply of free organs seems a "reasonable price to pay for an overall increase in the availability of organs." 107 Reasonable or not, an organ draft would occasion no such price. Cognizant of ethical and moral objections to organ sale, those who advocate an organ market urge that sale is neither unethical nor immoral. They argue that a policy that supplies more needed organs is ethically superior to one that supplies fewer and that "one who relinquishes an organ 'for money' may well have an altruistic motive-specifically to acquire income to provide his family with advantages he could not otherwise obtain." 10 8 Furthermore, one author observes, that the transplant surgeons who object on moral grounds to the purchase and sale of organs charge a fee for transplant surgery and that when an organ is transplanted many people other than the donor will be paid for their part in the operation.109 "If you suggest somehow it's immoral for the donor to get paid, then you have picked him out from among all these other people as being the one whose contribution to that operation is the contribution which should not be paid for."110 But many people do believe that humanity is debased when one individual endeavors not to keep, not to give, but to sell certain aspects of his or her being."' Perhaps this is the reason that under state and federal statutes one may not sell his life, his freedom, his children, or his sexual partnership. And, right or wrong, federal law now proscribes the sale of organs as well.' The debate on purchase and sale of organs is and ought to be moot. It is not here contended that an organ market is inherently bad, only that, in comparison with an organ draft, it is an inferior solution to the national organ shortage. It cannot meet our nation's need for organs . Comparatively better than organ sales – far more supply without exploitation risk Schwark, 10 - J.D. expected 2011, Cleveland State University. Cleveland -Marshall College of Law (David, “ORGAN CONSCRIPTION: HOW THE DEAD CAN SAVE THE LIVING” JOURNAL OF LAW AND HEALTH, Vol. 24:323, Hein) Realizing this pressing need, several proposed solutions have come forward. The least controversial, routine request, has also proven to be ineffective. Presumed consent, though better at obtaining organs, is really conscription in disguise and would amount to a taking without just compensation. Finally, an organ market of any kind would marginalize the poor and create a society where only the rich could afford organs, and the poor would be forced to sell their organs out of desperation. Organ conscription, with just compensation, is the best way to increase the organ supply and save the lives of those who desperately need an organ. By forcing donation, something that the vast majority of Americans agree upon, it would eliminate the need for transplant tourism and the black market. Since the taking would be compensated, it would fall in line with the Fifth Amendment. With a simple exception for religious beliefs, it would not violate the free exercise clause. Furthermore, it would not exploit the poor or underprivileged and would enable them to obtain life-saving organs as well. No other solution could likely provide as many organs. Organ conscription is therefore the best solution to the current organ shortage. Without this overhaul of our current organ donation system, many Americans will continue to lose their lives needlessly. Conscription isn’t mandated choice or presumed consent – it means 100% recovery Spital, 5 - Department of Medicine, Mount Sinai School of Medicine, New York, New York (Aaron, “Conscription of Cadaveric Organs for Transplantation: A Stimulating Idea Whose Time Has Not Yet Come” Cambridge Quarterly of Healthcare Ethics (2005), 14, 107–112) Part of the problem lies in overly conservative selection criteria, which now is being addressed through increasing acceptance of extendedcriteria and nonheartbeating donors. But in the United States, the most common reason for lost cadaveric organs is family refusal to allow organ recovery from a recently deceased loved one; about 50% of families say no. Several plans designed to overcome this family consent barrier have been proposed. These include adopting a system of presumed consent or mandated choice, and offering financial incentives to families who agree to donate. Despite growing interest in these proposals, all remain highly controversial. Furthermore, it is extremely unlikely that any of them could come close to achieving 100% efficiency of cadaveric organ procurement that patients with end-stage organ disease desperately need. However, there is another alternative that could approach this lofty goal: conscription of all usable cadaveric organs. What Does Conscription of Cadaveric Organs Mean? Under this plan, usable organs would be removed from all cadavers soon after death and made available for transplantation. Consent would be neither required nor requested. With the possible exception of exemption on religious grounds, opting-out would not be possible. Like a draft of military recruits, this would be a draft of organs. The CP procures almost 100% of organs with no risk of abuse Spital, 5 - Department of Medicine, Mount Sinai School of Medicine, New York, New York (Aaron, “Conscription of Cadaveric Organs for Transplantation: A Stimulating Idea Whose Time Has Not Yet Come” Cambridge Quarterly of Healthcare Ethics (2005), 14, 107–112) The most important advantage of conscription is that under this plan, the efficiency of organ procurement should approach 100%, which would dramatically increase the number of organs available for transplantation. As previously noted, it is highly unlikely that any other approach could do nearly as well. As a result of the increased availability of organs that conscription would provide, the lives of many more patients with end-stage organ failure could be improved and extended. Another advantage of conscription is that this system would be much simpler and less costly than other approaches to organ procurement. Under this plan there would be no need to search for the best approach for obtaining consent, no need for expensive, labor-intensive educational programs designed to encourage more people to say yes, no need to train requestors to obtain and document consent, no need to maintain donor registries, and no need for complex regulatory mechanisms to prevent abuse as would be required were financial incentives allowed . A third advantage of conscription is that because permission from the family would no longer be sought, this plan would eliminate the added stress that devastated families now endure when asked to consider organ donation in the midst of the grief and shock that follow the sudden death of a loved one. Furthermore, delays in organ recovery that result from the current need to wait for family approval, and that jeopardize the quality of organs, would be eliminated. A final advantage of conscription is that, in contrast to other approaches to organ procurement, it satisfies the principle of distributive justice, which refers to equitable sharing of burdens and benefits by members of the community. Under conscription, all people who die with usable organs would contribute to the cadaveric organ pool—there would be no more “free riders” 1—and all people would stand to benefit should they ever need an organ transplant. This contrasts with our current system in which people can refuse to donate and yet compete equally for an organ with generous people who choose to give. AT: PERM DO BOTH The CP alone creates a legal bright line. The perm is the worst of all worlds – mixing sales with conscription blurs the line, wrecks public trust or the ability to create social change in the medical system, subjects the government to costly litigation that inhibits organ use and institutionalizes exploitation and abuses Neri, 2 - Rebecca M. Neri, Esq., J.D. 2002, Syracuse University 2002; B.A. 1999, Hobart and William Smith College. Ms. Neri is the Digest Form and Accuracy Editor and is an Associate of Devorsetz, Stinziano, Gilberti, Smith & Heintz in Syracuse, New York (“New Organ Donations” 10 Digest 67, lexis) subjecting corpses to traditional property reasoning, and consequently, to judicial resolution creates a blanket disincentive to individuals, [*77] families, and members of the transplant community, including doctors, donors, and transplant centers, to participate in organ donation. Essentially, the total costs, in terms of money, time and emotional 3. Entering Into a Discussion about the Body as a Commodity - As mentioned briefly above, expenditures, simply do not outweigh the benefits (i.e., a family knowing their gift let some stranger live). Additionally, requiring the government to set prices for organs offends public policy because it permits the government to participate in organ selling and requires the government to set a value scale for each organ procured. Economically, the government and the people cannot afford to purchase the organs needed to satisfy the deficit, nor can either afford to be tied up in litigation while the organ's value dies with its body. In this sense, discussing the body as property inhibits the goal of increasing organs by increasing the amount of red tape one must go through to donate. Nationalization (or the creation of a public right) of human cadaveric organs could also result in serious human rights violations. n46 A simple, more efficient way of thinking that embraces societal problems surrounding organ donation, while shaping public sentiment must take the place of considering the body as property. Initiating market responses to this problem is not the simple, more efficient way of thinking. Despite this, many argue that a market approach to organ donation could indeed remedy transactional costs as well as eliminate the need for litigation over governmental takings. Additionally, these market advocates feel financial incentives are the most efficient means of remedying the organ shortage. For example, in a recent work David Jefferies proposes that "the most effective way to increase the supply of organs will involve limited commercialization of bodily components." n47 In his view, the law should provide for the use of a "middleman" who has the authority to contract for organs and could halt potential abuses. n48 Upon the death of a willing and contracted donor, doctors would remove the organ(s), and then the appropriate consideration for the organ would change hands. n49 Jefferies then proposes that an organ procurement network set up an altruistic-based distribution system, rather than one conditioned on wealth. n50 This proposal is not an answer to the inefficient means of organ procurement. As will be shown in Section Three, infra, market theories are inefficient and costly. First, contracting for body parts will require more litigation to establish rules, interpret the rules, and to enforce the rules, requiring efforts of all [*78] branches of government and the private sector. n51 Second, a contracting scheme exacerbates public fears, rather than reshaping them towards a better awareness of death, in that a contract for your organs might breed paranoia that someone is trying to "snatch" the "goods" prematurely. III. Critique of the Market Alternatives As stated above, applying a market strategy to remedy the current organ deficit is neither a more efficient, nor a more practical remedy to the organ deficit problem. A market in organs creates paranoia rather than destroys societal fear, and as such, does not incorporate the goal of shaping a new public sentiment. Though it might eventually alleviate the organ deficit, the selling or contracting of organs would invite human rights abuses, such as body snatching, despite retaining the specter of individual autonomy and public control. This section makes the case that a market remedy for the organ shortage would present more obstacles to meeting the demands for organs. Specifically, this part argues that a market strategy denies the power of substantial societal value systems (such as common notions of ethics and human rights), and favors a select part of the population. After discussing current market proposals and the particular faults of the trendy market cure, the discussion will turn to why market theories are incapable of reshaping the societal preference towards organ donation. A. The Trend of Market Solutions Many scholars have proposed market systems as a cure for the organ deficit. n52 Specifically, those in favor of creating an organ market have argued that since altruistic systems have failed to produce the necessary organs, self-interest in consideration might provide the adequate incentive to donate. n53 Their basic argument is that in the market, the supply would be self-regulating because rising demand would raise the price of tissues in short supply and produce incentives for individuals to sell their organs; these prices would ensure that enough organs would be available to meet demand. n54 With the demand for organs being met through a market system, these scholars argue that the market is the most efficient system of resource allocation, and that the market would alleviate the imbalance of how benefits and burdens between the donor and recipient are distributed. n55 Thus, economically speaking, [*79] Pareto efficiency is attained - the exchanges are consensual, voluntary, and utility is maximized. n56 Variations to the basic supply and demand model have also been proposed. For example, Lloyd Cohen argues for a "futures market" to cure the organ deficit. n57 Specifically, Cohen proposes that "healthy individuals be given the opportunity to contract for the sale of their body tissue for delivery after death." n58 Some would offer alternative methods of exchange, namely, promises to donate organs in exchange for health insurance, tax breaks, death benefits, public recognition of the donation, or a bartering system to secure other necessities. n59 Regardless of the economic model proposed or the mode or currency of exchange, each purports to disburse ethical and human rights concerns that arise from the notion of selling one's organs. The most cited fear about creating a market in organs is the exploitation of the weak, elderly, poor, and the power the market gives to the wealthy. n60 Another important ethical problem a market must deal with is whether thinking of the body as a commodity is even appropriate. n61 All proponents of a market system insist that heavy regulation and the creation of strict criteria for both the procurement and allocation of organs would remedy ethical concerns. n62 Any market system proposed will surely exploit the poor. First, any market theory that relies on the availability of The poor, by virtue of their economic state are not in a position of bargaining power. The poor do not have anything to give to enable the receipt of an organ, and they are easy targets for unscrupulous organ harvesters who would offer them a "meal for their left eye." The tension of economic hardship hardly something to exchange, and the willingness of participants to exchange necessarily inhibits the participation of the poor. provides an optimal market scheme of voluntary and consensual exchanges. Additionally, market systems that require heavy regulation are neither economically nor politically efficient. Regulation necessitates a degree of complex rules, requiring judicial and legislative interpretation. In turn, market regulation of this sort also becomes the embodiment of a recognized property right in one's body. As mentioned above, inviting the body to interpretation as property brings its own set of ethical problems, as well as problems for procuring organs. By entering the body into the stream of commerce, people would most likely seek enforcement of property rights to their body, including rights to privacy, [*80] control, and transferability. People might also fear the possibility that their bodies could escheat over to the state once their body becomes a commodity in the stream of commerce. The remedy to this result would be regulation, which in turn forecloses on individual autonomy. In sum, the free market alternatives to the current system of altruism create rather than destroy social and ethical barriers to efficient organ procurement. This section attempted to illustrate that although the exchange of organs on the free market appears to provide individuals with a great degree of control over the disposition of their bodies, such control is dampened. That damper is created in the face of ethical concerns relating to the exploitation of the poor, and the end result of having to provide for property rights in the body. B. Market Models Fail to Shape a Preference to Donate Market paradigms purport to shape individual preferences to donate by insisting that people act in their own best interest. In other words, a market paradigm attempts to create specific opportunities for the public so that the beneficial, logical preference for the individual is to donate their organs. n63 In this sense, using a market strategy to provide organs must show that donating outweighs social costs associated with selling organs. n64 This part proffers that the basic supply and demand market paradigm in which money is exchanged for organs is ineffective in providing the public with the means to effectively weigh the social costs and benefits of donating organs. In this sense, the prevailing societal preference under a market system would continue to deplete the organ supply. Thus, any proposed market cure fails as a viable option to correct the current organ shortage. Humans generally act in their own best interest, though, for the most part, they align with the sense of greater social values. Indeed, some individuals act in accordance with what one author has termed, "socially responsible reasoning," which take humans beyond being purely selfish actors. n65 Markets do not function on exchange alone; they inevitably encompass institutional values, such as social preferences. n66 However, the prevailing social preference of a market in human organs might very well be corrupt at its core, and thus, incapable of providing a structure that weighs the personal costs against the social benefits to organ donation. The corruption lies not in the potential for market abuses, but rather in the existing social consciousness of the population. As mentioned above, the six [*81] most popular reasons people give for not donating organs are: "hastiness of organ retrieval and a feeling that declaration of death and immediate subsequent removal of organs interferes with the family's expression of grief; mutilation; fatalism and superstition; religion; age and ignorance." n67 If the greater social value of organs is to prevent their being interred without harvesting and to save lives, then the market must arrange itself around enabling people to weigh their cost or fear concerning donation. But how is a market to do this when, in fact, the incentive is merely valued in fiscal terms? How can a market theory, which relies on the wealth of its participants more so than the social justice of its actors effectively push social mores towards weighing the benefits of giving over the cost of facing ones personal fears? It simply cannot. Though any market incentive might push people towards realizing that money is preferable in exchange for needed organs, the market incentive simply fails to account for the underlying fears of the people concerning donation. The market cannot provide a structure in which ordinary people can rationally weigh costs and benefits of organ donation, because the market lacks sufficient grounding in the irrational fears concerning donation. A pure incentive program that replaces altruism with cash, or other necessities is inadequate as it falls short of effectively replacing existing social fears connected with donating organs after death. If there really is to be any increase in the organ supply, the answer lies in reshaping society not through a free market and property system, but rather, through structuring discussion around changing social values at their core . IV. The Conscription Cure: Mandatory Cadaveric Organ Donation The general will is always right, but the judgment that guides it is not always enlightened. It is therefore necessary to make the people see things the way they are<elip>to point out to them the right path they are seeking. Some must have their wills made to conform to the reason, and others must be taught what it is they will. From this<elip>would result the union of judgment and will in the social body. From that union comes the harmony of the parties and the highest power of the whole. n68 Earlier in this article, it was suggested that neither the current altruistic organ donation, nor trendy market proposals that seek to cure the organ deficit work. n69 It has also been suggested that assigning property concepts to bodily organs, such as control, transferability and privacy would neither efficiently deal with the organ shortage, nor incorporate a means of social change. In this section, it [*82] will be proved that mandatory organ conscription is the most efficient way to cure the deficit and reshape social values. Specifically, this part first discusses the doctrine of conscription, the details how conscription purports to embrace social values and fears in such a way that will mold society into accepting cadaveric organ conscription. For the purposes of this article, the discussion will focus on the general policy of a conscription plan. Specific legislation would be needed to implement such a plan, but I leave those details for later investigation. In doing so, I briefly touch on presumed consent laws, because they closely relate to the goal of curing the organ deficit, and are a step on the same path as mandatory conscription. A. Presumed Consent: A Step in the Right Direction This section discusses the presumed consent system for organ procurement. Under this system, the presumption is that unless otherwise expressed and recorded, the decedent has consented to the removal and donation of all needed organs after his or her death. n70 In the European Union, this practice appears favored over other market remedies because a market approach seems "inconsistent with the EU objective of a high level of consumer protection [and] the negative opinion of the European Parliament on commercialization or organs<elip>." n71 Ideally, presumed consent systems eliminate the need to seek out the donative intent of the deceased through his family or other means. Despite this intent, some European countries still insist on inquiring into the wishes of the family, while other countries immediately remove organs at the point of death unless there is clear evidence the deceased desired otherwise. n72 Regardless of the standard employed, the European system is still more effective than the current altruistic system of the United States. n73 Practically speaking, the European model has its advantages: no need to carry donor cards, no need for last minute decision-making, and no need to ask for permission from families to harvest. This system also preserved the semblance of respect for individual autonomy as individuals are on notice to object to harvesting. n74 This system is not without its imperfections. In practice, most physicians seeking donation still inquire into the family's wishes. n75 It also does not embrace [*83] the moral objections families or individuals have regarding donation. n76 In other words, those who objected for moral or social reasons under the system of volunteerism will probably still object under the presumed consent system. Thus, the goal of substantially increasing organ donation (as well as reducing transactional barriers) is not accomplished. B. The Principles of Conscription This section discusses the virtues of conscription. A general policy towards conscription of organs would empower every medical provider to harvest "every cadaveric organ suitable for transplantation without regard to any contrary wishes expressed by the decedent while he lives or by surviving relatives after he dies." n77 A system that permits the removal of all necessary organs at death by medical providers is also the most efficient means of producing the necessary supply of organs. A blanket rule such as this reduces judicial and legislative deliberation over the interpretation of the rule, and demolishes the barriers created by thinking of the body as property. Conscription would not require a "promotional campaign, compensation to donors, or even attempts to gain permission from donors and their families." n78 Conscription would also remove some medical liability issues: specifically, doctors would no longer be liable for failing to obtain consent, nor would they have to be burdened by seeking out consent before donations could be made. n79 Other plans, such as the current volunteerism and the proposed market structures also purport to retain individual autonomy as well as to operate within the framework of the Constitution. For example, advocates of volunteerism suggest that permitting individuals to choose whether to donate encourages charity and generosity. n80 Under this system, generosity and charity drive donating; conflicts between family and individual autonomy are eradicated; and individual autonomy is retained despite the degree of legitimate coerciveness, as it implements greater social good and common will. n81 It is not individual autonomy in the sense of choice, rather, it is individual autonomy in the sense that with enough organs available, a person's capabilities are increased should a personal need for organs arise. Thus one can live freely and have a more productive life. n82 Some would argue that choice is the touchstone of American freedom, and choice includes the right to direct the disposition of one's body. Yet, in times [*84] of national crisis (or even potential crisis) the population must be directed to join into the greater social good; it is for this reason there is a military draft, as well as prohibitions against assisted suicide. n83 The law has always provided for legitimate yet coercive means of shaping public attitude towards a greater public good. Conscription of organs is not unlike these examples. C. The Plan: How Conscription Shapes Social Values Conscription merely purports to erase all notions of familial and individual property rights in dead bodies. In doing so, the body will not and cannot be commodified, nor will it escheat over to the state. Instead, conscription will provide the medical community with the resources it needs to fulfill a need for organs. Conscription is the most efficient bright line rule the legal system can offer the public and the medical field. As stated in the introduction to this paper, discussions regarding religious objections to conscription are outside the scope of this paper. Ethically, understanding what it is that the public values and fears most about donating their organs will be crucial to initiating social change towards conscription. Such values include the ability to grieve, individual autonomy, superstition, fear of mutilation, fear of desecration, unwarranted governmental intrusion and religious objection. Arguably, conscription neither denies nor promotes any of these common fears: families will not have to face the decision of whether to donate, and for all intents and purposes, bodily forms stay intact after select organs are harvested; individual freedom is retained in the sense that human growth potential and aligning with a common good will be promoted; and under conscription, the government relinquishes control to the transplant community. Conscription also alleviates the fear of exploiting the poor, and the over representation of wealthy recipients who have greater bargaining power. Conscription does not favor the wealthy, nor does it prey on the poor . Conscription creates no hold-out power for those whose organs are desperately needed. V. Conclusion There is a desperate need for organs in America. Patients lose their freedom and ability to live up to their potential: instead, thousands awaiting transplantable organs are dying needlessly as thousands more healthy, viable organs are interred. Social values and ideologies, as they stand today, can be flexed and molded into a new ideology: one of ultimate giving. Conscription provides the cure for the needless deaths; though the rule is radical, it is appropriately coercive. The conscription cure is able to flex social values into new values, such as placing the highest priority in life on saving lives. Links to exploitation DA – 1nc Capron says US moral authority to pursue a global organ sales ban and crack down on organ trafficking depends on credibility to oppose sales domestically. Even if the CP fully resolves the US organ shortage, Capron says there’s still a need to maintain pressure for criminalization of sales internationally This explicitly cracks existing international attempts at control – that’s 1nc Budiani-Saberi The permutation is net negative even if sales are a last resort – it causes global defection from the organ regime Budiani-Saberi, 9 - Dr. Budiani-Saberi is the Executive Director of the Coalition for OrganFailure Solutions (COFS). She is a medical anthropologist and has conducted extensive research on organ trafficking, including longitudinal follow-up studies and outreach on commercial living organ donors, assessing health, economic, social and psychological consequences (Debra, “Advancing Organ Donation Without Commercialization: Maintaining the Integrity of the National Organ Transplant Act” https://www.acslaw.org/publications/issue-briefs/advancingorgan-donation-without-commercialization-maintaining-the-integ-0) The OTPA‘s introduction of material incentives to organ donation would undermine these other important initiatives and the potential they have to enhance organ supplies. Material incentives, even as a final resort, should not be considered, particularly when there are significant strides to be accomplished in advancing deceased and altruistic donation. Slavish devotion to market-based solutions should not distract Congress‘s attention from these attainable solutions. V. Conclusion Transplants are said to be the most social of therapies. They rest on public trust in medicine. Transplant commercialism and organ trafficking worldwide have exploited social vulnerabilities to obtain organs for transplant. Although operating in various models, these practices inevitably target the impoverished and lead to inequity and social injustice. OTPA‘s aim to permit compensated organ donation is contrary to the global movement to oppose commercial transplantation. The United States‘ transplant policies are important references for the rest of the world and are influential in shaping consideration of material incentives in countries that would not necessarily commit to regulation or best practices in donor care. As illustrated at the beginning of this paper, Yuri resorted to selling a kidney when his poor living conditions became especially destitute and the reward particularly appealing. Those conditions drove him to the donation and he regretted the decision afterwards. Existing transplant commercialism operates in countries that are, by definition, different from the United States. Although proponents of compensated donation suggest that the experience would be different in the U.S., individuals are similarly likely to resort to a donation when compensation includes rewards such as comprehensive health care for life, health and life insurance, disability and survivor benefits or educational benefits. Like the cash payment to Yuri, these forms of compensation are considered to significantly enhance the life of an individual who cannot afford these basic needs. The United States must join the international community to rebuild, not compromise, trust in transplants. This is especially important at this moment when markets have failed economic and social needs in global and historical dimensions and altruism has become especially priceless. Guided by the WHO resolution on organ transplants and the Istanbul Declaration, transplant practices can advance standards of greater social equality rather than exploit people in poverty. There are many opportunities to advance organ donation in the U.S. without subjecting individuals to experiences such as Yuri‘s. Legalization of organ sales causes organ trafficking---it promotes inconsistent norms and undermines enforcement mechanisms Delmonico 11 (Francis L., Director of the Renal Transplantation Unit – Massachusetts General Hospital, Medical Director – New England Organ Bank, “The Declaration of Istanbul Is Moving Forward by Combating Transplant Commercialism and Trafficking and by Promoting Organ Donation”, American Journal of Transplantation, 12(3), 515-516) The commentary by Drs. Ambagtsheer and Weimer provide an interesting criminological reflection regarding the Declaration of Istanbul in which they question whether efforts to prohibit organ trade have been either realistic or effective since its widespread adoption (1). They challenge the link of organ trafficking to transplant commercialism and drawing comparison from other demand crimes, speculate that the regulation of commercialism would be feasible and justified in the prevention of trafficking. However, the proposal to curtail trafficking by the regulation of monetary payments for organs is not convincing. Organ trafficking is indisputably linked to commercial profits and distinguishable from other demand crimes. The prohibition of both transplant commercialism and trafficking is required as essential to provide the criminological mechanism for detection and enforcement efforts. The ultimate value of the Declaration of Istanbul as effective policy exists not only in its prohibitionist stance but also in its promotion of effective donation and transplantation systems to reduce the demand for transplant tourism that gives rise to organ commercialism and trafficking. Transplant commercialism is linked to organ trafficking: The Declaration of Istanbul defines transplant commercialism as a policy or practice in which an organ is treated as a commodity, including being bought or sold or used for material gain. The recommendation of Ambagtsheer and Weimer to disassociate transplant commercialism from organ trafficking is belied by the international realities (1). Organ trafficking exists only in the realm of commercialism—the intent to make profit. Profit is what propels brokers to prey upon refugees from the Sudan and victims of tsunami catastrophes or other vulnerable groups to sell their kidneys. The regulation of monetary payments for organs is not feasible and cannot be justified: Financial incentives for organ donation that provide monetary gain cannot be regulated. Public policy that promotes such incentives becomes veiled programs of organ sales. Once a scheme that offers money as the motivation for “donation” becomes the policy or tolerated practice in one country, it leads to the development of competitive schemes in other countries. Countries are indeed soliciting thousands of patients to travel to foreign destinations for medical care. But transplant tourism is different than medical tourism because of the documented harm that occurs to paid donors. To cite programs that aim at “harm reduction for prostitution” as the basis for supporting payments for organs debases organ donation as a medical procedure and is contradicted by the harm that continues by “regulated” programs of prostitution. Organ prohibitions are unique---criminalization provides a legal mechanism to stop organ trafficking Delmonico 11 (Francis L., Director of the Renal Transplantation Unit – Massachusetts General Hospital, Medical Director – New England Organ Bank, “The Declaration of Istanbul Is Moving Forward by Combating Transplant Commercialism and Trafficking and by Promoting Organ Donation”, American Journal of Transplantation, 12(3), 515-516) Member states of the WHO understandably reject such public policy because these schemes quickly lead to the exploitation of individuals who are poor or destitute. The WHO is not alone in denouncing this contention by Ambagtsheer and Weimer. The Directive of the European Union on Human Tissues and Cells states the following: “As a matter of principle, tissue and cell application programs should be founded on the philosophy of voluntary and unpaid donation, anonymity of both donor and recipient, altruism of the donor and solidarity between donor and recipient” (2). In July, 2010, the European Parliament and the Council affirmed that organ donation must be voluntary and unpaid (3). The difference between illicit drugs and transplantable organs as demand crimes: The premise of Ambagtsheer and Weimer's position is that prohibitionist policies for demand crimes are ineffective. However, unlike drugs or other demand driven crimes, organs are useless unless transplanted. Successful organ transplantation requires sophisticated cooperation between licensed professionals and licensed facilities to provide such medical care. In contrast, drugs once purchased can be used illicitly without the involvement of medical professionals. For this reason, Ambagtsheer and Weimer's citing the “war on drugs” as the primary illustration of the failure for prohibition to reduce criminal behavior is not a valid comparison in the context of organ trade. Trafficking requires a complicit surgeon. This comparative difference from other demand crimes and its impact on the criminological value of the Declaration of Istanbul must be considered. The necessity of prohibiting transplant commercialism and organ trafficking: Ambagtsheer and Weimer argue that the Declaration of Istanbul's prohibition will not be effective in deterring organ commercialism and trafficking. However, it is the act of criminalizing organ commercialism and trafficking through adoption of the Declaration of Istanbul principles that provides the legal mechanism to organize detection and enforcement efforts. The ultimate value of prohibiting transplant commercialism and organ trafficking should not be solely measured by commensurate reduction in criminal behavior. The necessity of prohibiting organ trade is to sustain human dignity (otherwise clearly violated in the exploitation of the destitute) and preserve organ donation as an altruistic gift. The perm doesn’t eliminate disads to living organ sales Spital and Taylor, 8 – Department of Medicine, Mount Sinai School of Medicine, New York, New York (Aaron and James “In Defense of Routine Recovery of Cadaveric Organs: A Response to Walter Glannon” Cambridge Quarterly of Healthcare Ethics (2008), 17, 337–343 In one of our editorials we stated that under routine recovery there would be “no need to consider paying for organs.” 2 Glannon points out that routine recovery would not eliminate the possibility of buying organs from living vendors (note that one who sells is not a donor) and therefore that ethical concerns about organ sales would persist. We agree. What we meant and should have said in our editorial is that under routine recovery there would be no need to consider paying for cadaveric organs. But the fact that our proposal would not eliminate the possibility of organ sales and the ethical quandaries that accompany them has no bearing on its acceptability. AT: 50 STATE FIAT Topic education – they kill core debates – this also proves the CP is predictable for organ law Silver, 88 – Assistant Professor of Law, Touro College, Jacob D. Fuchsberg Law Center. (Theodore, “The Case for a Post-Mortem Organ Draft and a Proposed Model Organ Draft Act” 68 B. U. L. Rev. 681 (1988) It was to these shortcomings that the National Conference of Commissioners on Uniform Law addressed to draft the Uniform Anatomical Gift Act (the "UAGA"). 5' In 1968 the Commissioners approved the UAGA and by 1972 the District of Columbia and all fifty states had enacted it,52 some with itself in 1965 when it began minor variations from the original. 53 The UAGA was amended in 1987 to "simplify the manner of making an anatomical gift."54 The UAGA, as amended, provides that a decedent who properly executes a gift while she lives will prevail over her survivors when she dies. 55 It establishes a relatively simple donation procedure involving what is commonly called a "donor card." 56 If the decedent fails to make a gift, her close relatives are empowered to donate her body parts provided they know of no contrary wishes of the decedent or of other relatives standing higher on the statutory hierarchy (spouse, child, parent-guardian). 57 Similarly, if a surviving relative authorizes donation, a recipient must refuse it if she knows of objections by the decedent or a relative higher on the hierarchical ladder than the one authorizing the donation.M The UAGA also subordinates itself to statutes that specify circumstances under which the coroner or medical examiner is requested to perform an autopsy.5 9 The authors of the 1968 UAGA describe the competing interests they wish to balance as: (1) the wishes of the decedent during his lifetime; (2) the desires of the surviving spouse or next of kin; (3) the interest of the state in determining by autopsy the cause of death in cases involving crime or violence; (4) the need of autopsy to determine cause of death when private legal rights are dependent on such a determination; and (5) the need of society for bodies, tissues, and organs for medical education, research, therapy, and transplantation. 60 The UAGA definitively resolves the ambiguities surrounding state donation statutes and the common law. It does little, however, directly to foster organ donation. Its chief effect is to define the rights of parties interested in the decedent's remains. III. THE FAILURE OF ENCOURAGED VOLUNTARISM AND A PROPOSED ORGAN DRAFT That the UAGA has had any positive impact on the supply of transplantable organs is hard to assert or deny, but the rate of organ donation from donor cards is low. 6' There is no question that since 1972 when the fiftieth state adopted the UAGA, the organ shortage has persisted, and that any relief wrought by the UAGA is small. 62 Indeed, the Commissioners on Uniform Laws amended the UAGA in 1987 because, according to their research, it was "not producing a sufficient supply of organs." 63 The amendments, however, were designed only to "simplify the manner of making an anatomical gift and require that the intentions of a donor be followed."64 As an instrument of organ procurement, the UAGA embodies a policy called "encouraged voluntarism. ' 65 Some argue that this policy ought not to be abandoned and that it should, for many reasons, continue as the basis of national organ procurement. Others regard encouraged voluntarism as a failed policy and suggest alternatives. These include: (1) a commercial market in which transplantable organs would be bought and sold; 66 (2) a "presumed consent" system in which decedents and survivors would be deemed to donate organs unless they affirmatively express an objection;6 7 and (3) a "routine inquiry" scheme continuing the prohibition on organ removal without the express consent of donor or survivor but meanwhile requiring that hospital personnel approach surviving families and raise the issue of organ donation.6 This Article proposes a straightforward conscription of transplantable organs post-mortem. Subject to religious exemption, the proposed Model Organ Draft Act 69 (the "Act") authorizes physicians and hospital personnel to remove from any cadaver such organs as would be useful to a living patient70 registered with a central registry. 71 Organs would be evaluated and removed without consent of either the decedent or her survivors.72 This Article suggests that this proposed organ draft is superior to encouraged voluntarism and to the proposed policies of organ sale, presumed consent, and routine inquiry. 6 The CP mechanism is legit – the UAGA was drafted by the NCCUSL Schwark, 10 - J.D. expected 2011, Cleveland State University. Cleveland -Marshall College of Law (David, “ORGAN CONSCRIPTION: HOW THE DEAD CAN SAVE THE LIVING” JOURNAL OF LAW AND HEALTH, Vol. 24:323, Hein) In 1954,22 doctors successfully transplanted a kidney from one twin to the other in one of the most important medical procedures in the past century .23 By 1967, experimental heart and liver transplantation were performed successfully. 24 These medical breakthroughs required individual states to begin passing legislation in an attempt to control the new developments.25 Finally, nationwide regulations were deemed necessary, and in 1968, the National Conference of Commissioners on Uniform State Laws ("NCCUSL") drafted the Uniform Anatomical Gift Act ("UAGA"), which provided for uniform regulation of anatomical gifts and defined persons who could gift their organs. 26 The goal of the UAGA was not only to regulate, but also to encourage donation.27 In 1984, Congress passed the National Organ Transplant Act ("NOTA"), which made receiving "valuable consideration" for an organ a federal offense, punishable by up to $50,000 and five years in prison.2 8 A. The Uniform Anatomical Gift Act The 1968 UAGA allowed individuals to donate organs, eyes, and tissue as gifts to a known donee or to any donee that might need an organ to survive. Though it did not explicitly state that organs could not be given for compensation, it was interpreted to restrict donation only to "gifts."30 The UAGA made a variety of advances in the law of organ donation, standardizing the process in each state and enabled individuals to donate organs, eyes and tissue to any donee that needed an organ to survive." The significant provisions expressly allow donations for medical, research, and educational purposes;32 give priority to the wishes of the deceased;" and set out a prioritized list of the next of kin authorized to donate where the wishes of the deceased are unknown.3 4 It was assumed no organs could be removed for transplant absent an explicit consent to donate."5 Soon after, all fifty states had adopted some form of the Uniform Anatomical Gift Act.36 Unfortunately, the 1968 UAGA did not achieve its goal of significantly increasing donation. 37 This fact, combined with the explosion of organ transplantation that occurred beginning in the 1980's, the recent passing of NOTA and the fear of a market for kidneys, 38 led the NCCUSL to amend the UAGA in 1987. The 1987 amendment addressed the changes in organ donation caused by the increase in organ transplantation.40 Some of the changes included prohibiting the sale of organs at death, 4' reducing formalities of executing the donative document,42 prioritizing donor consent over family objection,4 3 and allowing medical examiners to release any usable organ for transplantation.44 Furthermore, the 1987 UAGA reinforced a trend in presumed consent statutes when it recommended presumed consent for the donation of any organ or tissue from cadavers under the custody of coroners or medical examiners.45 Unlike the original act, which was swiftly adopted by all states, the amendment faced stiff resistance.46 Eventually, twenty six-states adopted the 1987 revisions.47 This resulted in non-uniformity of state laws, which was only increased by subsequent changes by individual states.48 2NC CROWDOUT TURN Altruistic donation can’t successfully coexist with organ sales – 1nc Capron says crowdout is more likely because people are unlikely to undergo the invasive and painful process of donation for a family member or friend if they know they could just buy an organ. Prefer it a. It’s based upon extensive empirical studies of pediatric kidney donations that confirm crowdout b. Magnifies the link to exploitation – crowdout paradoxically creates a shortage, which increases prices and makes sellers more vulnerable to the black market Legalization decreases supply – crowd out effects are greater Capron et al, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “Organ Markets: Problems Beyond Harms to Vendors”, American Journal of Bioethics, October, Volume 14, Number 10, 2014) There are several reasons why a regulated market will not increase the net supply of organs. First, experience shows that paid donation does not add to the organ supply but merely replaces unpaid donation; conversely, prohibiting payment actually increases the supply. For instance, several years ago, after Israel stopped paying for its citizens to go to countries where they could get transplants with purchased kidneys, the numbers of both deceased and living related donors rose dramatically (Lavee et al. 2013). The phenomenon of “crowding out” occurs for two reasons. Psychic and reputational benefits to donors—both living individuals and the families of deceased patients— disappear when organ donation is no longer associated with altruism but with payment. Furthermore, potential recipients are reluctant to enter into the complex “gift relationship” that arises when a relative or friend donates an organ if instead they can obtain a kidney from a stranger in an arm’s-length commercial transaction (Ghods, Savaj, and Khosravani 2000). Likewise, potential related donors no longer feel obligated; recently, when the U.S. rules for allocating deceased donor kidneys were changed to give children on the waiting list greater access to deceased adult donors’ kidneys, parental donations fell by a larger amount, so that overall fewer pediatric kidney transplants are being done while some potential adult recipients have been deprived of a kidney that went to a child instead. Further, in all settings where kidneys have been market commodities, the act of selling a kidney is seen as debasing, something that a person would do only if he or she had no other means of survival. A regulated market won’t change that. Indeed, it is likely that means would arise to circumvent the intended limitations on the incentives, such as financial entrepreneurs arranging for poor kidney sellers to obtain a lesser sum in cash in exchange for the money deposited into a retirement account for them. From the viewpoint of transplant programs, this would have the advantage of producing more kidneys (since in all societies the poor are the readiest source of organs), but very unjustly and by making a mockery of the notion of a “regulated” market. Crowdout doesn’t occur in Iran solely because the major deceased donor program prohibits sales Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25) 160. A.H. Rizvi, A.S. Naqvi, N.M. Zafar & E. Ahmed, Regulated Compensation Donation in Pakistan and Iran, 14 CURRENT OPINION IN ORGAN TRANSPLANTATION 124, 127 (2009) (arguing that paying for kidneys has forestalled development of deceased-donor programs, which are needed for other solid organ transplant programs). The deceased donation that occurs in Iran, which is sometimes cited to show that reliance on paid donors does not depress deceased donation, actually results from the rejection of the national norm by one major center: Shiraz Organ Transplant Centre is the largest centre [in] Iran performing liver and kidney transplant from deceased donors. They started their programme with kidney transplantation based on live altruistic donors without any monetary consideration in the name of compensation. They maintained their policy for several years and finally their credibility took them to becoming one of the largest centres of deceased liver transplantation in Middle East and today they are performing the highest number of deceased transplants. E-mail from Dr. Anwar Naqvi, Professor & Coordinator, Centre of Biomedical Ethics & Culture, Sindh Inst. of Urology & Transplantation, to author (July 19, 2013, 5:17 AM) (on file with author). The aff collapses organ supply: --Doctors Segev, 10 -- Johns Hopkins professor of surgery [Dorry, MD, PhD, and S.E. Gentry, Department of Epidemiology, Johns Hopkins School of Public Health, Department of Mathematics, United States Naval Academy, "Kidneys for Sale: Whose Attitudes Matter?," American Journal of Transplantation, 2010, 10, 1113-1114, ebsco, accessed 8-27-14] First, nothing else is relevant until physicians support organ sales. And, right now, they don't. In a recent survey of the American Society of Transplant Surgeons, only 20% of transplant surgeons-those actually doing the transplants-supported cash payments for deceased or live donation (2). Similar lack of support was found among physicians from other societies as well (3). Clearly an organ market will not be much of a market with so few willing to perform the transplants or refer the patients . And a rift in the transplant community resulting from a marginally sup- ported organ market will likely be much more detrimental to organ transplantation in the United States than any pu- tative increase in donation from establishing financial incentives (4). As such, those seeking to better understand the viability of organ markets should focus first on the physicians. RISK (2NC) A legalized organ sales market would negatively impact African Americans. Goodwin 07 “The Body Market: Race Politics and Private Ordering.” Michelle Goodwin (Visiting professor at the University of Chicago Law School, Everett Fraser Professor of Law and Professor of Medicine, University of Minnesota.) Arizona Law Review Vol. 49:599. 2007. 599636. http://www.arizonalawreview.org/pdf/49-3/49arizlrev599.pdf //CChappell “Buy or Die” was the theme of a recent symposium on organ markets at the American Enterprise Institute hosted by Sally Satel.1 The symposium reflected a significant departure from traditional organ transplantation discourse. The symposium was an effort to study alternatives to the conventional discourse on organ procurement, specifically by a sustained dialogue on incentives. However, one reporter found a particular panel, Giving and Selling, to be hostile to medical ethics and well-established social norms.2 The reporter compared proposals to cure the shortage of transplantable org ans in the United States with the lessthanfavorable markets in Iran and the black market in prisoner’s organs in China. The same reporter then offered a challenge to markets that silenced the room. She prophesied that poor minorities in the United States would be abused by compensated body-market systems. The reporter evoked the image of poor, powerless Black Americans becoming the surgical pawns of wealthy, presumably white transplant patients. This appeal was seductive, an easily captured image, pregnant with the backdrop of U.S. history. Perhaps for that reason, opponents to incentives in organ regimes argue that private ordering in organ procurement would sanction a neoclassical form of slavery. The reporter’s passionate race-based challenge to organ incentives illustrates the presence of race and political correctness in organ transplantation discourse. Anti-commodification scholars insist that race matters in organ transplantation .3 This is offense Fitzsimmons 7 (Michael, “The Problem of Uncertainty in Strategic Planning”, Survival, Winter 06/07) But handling even this weaker form of uncertainty is still quite challeng- ing. If not sufficiently bounded, a high degree of variability in planning factors can exact a significant price on planning. The complexity presented by great variability strains the cognitive abilities of even the most sophisticated decision- makers.15 And even a robust decision-making process sensitive to cognitive limitations necessarily sacrifices depth of analysis for breadth as variability and complexity grows. It should follow, then, that in planning under conditions of risk, variability in strategic calculation should be carefully tailored to available analytic and decision processes . Why is this important? What harm can an imbalance between complexity and cognitive or analytic capacity in strategic planning bring? Stated simply, where analysis is silent or inadequate, the personal beliefs of decision-makers fill the void. As political scientist Richard Betts found in a study of strategic sur- prise, in ‘an environment that lacks clarity, abounds with conflicting data, and allows no time for rigorous assessment of sources and validity, ambiguity allows intuition or wishfulness to drive interpretation ... The greater the ambiguity, the greater the impact of preconceptions.’16 The decision-making environment that Betts describes here is one of political-military crisis, not long-term strategic planning. But a strategist who sees uncertainty as the central fact of his environ- ment brings upon himself some of the pathologies of crisis decision-making . He invites ambiguity, takes conflicting data for granted and substitutes a priori scepticism about the validity of prediction for time pressure as a rationale for discounting the importance of analytic rigour. It is important not to exaggerate the extent to which data and ‘rigorous assessment’ can illuminate strategic choices. Ambiguity is a fact of life, and scepticism of analysis is necessary. Accordingly, the intuition and judgement of decision-makers will always be vital to strategy, and attempting to subordinate those factors to some formulaic, deterministic decision-making model would be both undesirable and unrealistic. All the same, there is danger in the opposite extreme as well. Without careful analysis of what is relatively likely and what is relatively unlikely, what will be the possible bases for strategic choices? A decision-maker with no faith in prediction is left with little more than a set of worst-case scenarios and his existing beliefs about the world to confront the choices before him. Those beliefs may be more or less well founded, but if they are not made explicit and subject to analysis and debate regarding their application to particular strategic contexts, they remain only beliefs and premises, rather than rational judgements. Even at their best, such decisions are likely to be poorly understood by the organisations charged with their implementation. At their worst, such decisions may be poorly understood by the decision-makers themselves. 1NR RISK (1NR) We can make practical choices with limited info—their threshold is perfection Cowen 4 – Economics, George Mason (Tyler, The Epistemic Problem Does Not Refute Consequentialism, http://www.gmu.edu/jbc/Tyler/Epistemic2.pdf, AG) If we know for sure which remedy works, obviously we should apply that remedy. But imagine now that we are uncertain as to which remedy works. The uncertainty is so extreme that each remedy may cure somewhere between three hundred thousand and six hundred thousand children. Nonetheless we have a slight idea that one remedy is better than the other. That is, one remedy is slightly more likely to cure more children, with no other apparent offsetting negative effects or considerations. Despite the greater uncertainty, we still have the intuition that we should try to save as many children as possible. We should apply the remedy that is more likely to cure more children. We do not say: “We are now so uncertain about what will happen. We should pursue some goal other than trying to cure as many children as possible.” Nor would we cite greater uncertainty about longer-run events as an argument against curing the children. We have a definite good in the present (more cured children), balanced against a radical remixing of the future on both sides of the equation. The definite upfront good still stands firm. Alternatively, let us assume that our broader future suddenly became less predictable (perhaps genetic engineering is invented, which creates new and difficult-to-forecast possibilities). That still would not diminish the force of our reason for saving more children. The variance of forecast becomes larger on both sides of the equation – whether we save the children or not – and the value of the upfront lives remains . A higher variance of forecast might increase the required size of the upfront benefit (to overcome the Principle of Roughness), but it would not refute the relevance of consequences more generally. We could increase the uncertainty more, but consequentialism still will not appear counterintuitive. The remedies, rather than curing somewhere in the range of three to six hundred thousand children, might cure in the broader range of zero to all one million of the children. By all classical statistical standards, this new cure scenario involves more uncertainty than the previous case, such as by having a higher variance of possible outcomes. Yet this higher uncertainty lends little support for the view that curing the children becomes less important. We still have an imperative to apply the remedy that appears best, and is expected the cure the greater number of children. This example may appear excessively simple, but it points our attention to the nonThe critique appears strongest only when we have absolutely no idea about the future; this is a special rather than a general case. Simply boosting the degree of background generic uncertainty should not stop us from pursuing large upfront benefits of obvious importance. generality of the epistemic critique. Predictions are good enough to act on. Their critique sets the bar too high Chernoff 9 (Fred, Prof. IR and Dir. IR – Colgate U., European Journal of International Relations, “Conventionalism as an Adequate Basis for Policy-Relevant IR Theory”, 15:1, Sage) For these and other reasons, many social theorists and social scientists have come to the conclusion that prediction is impossible. Well-known IR reflexivists like Rick Ashley, Robert Cox, Rob Walker and Alex Wendt have attacked naturalism by emphasizing the interpretive nature of social theory. Ashley is explicit in his critique of prediction, as is Cox, who says quite simply, ‘It is impossible to predict the future’ (Ashley, 1986: 283; Cox, 1987: 139, cf. also 1987: 393). More recently, Heikki Patomäki has argued that ‘qualitative changes and emergence are possible, but predictions are not’ defective and that the latter two presuppose an unjustifiably narrow notion of ‘prediction’.14 A determined prediction sceptic may continue to hold that there is too great a degree of complexity of social relationships (which comprise ‘open systems’) to allow any prediction whatsoever. Two very simple examples may circumscribe and help to refute a radical variety of scepticism. First, we all make reliable social predictions and do so with great frequency. We can predict with on extensive past high probability that a spouse, child or parent will react to certain well-known stimuli that we might supply, based experience. More to the point of IR prediction – scepticism, we can imagine a young child in the UK who (perhaps at the cinema) (1) picks up a bit of 19th-century British imperial lore thus gaining a sense of the power of the crown, without knowing anything of current balances of power, (2) hears some stories about the US–UK invasion of Iraq in the context of the aim of advancing democracy, and (3) hears a bit about communist China and democratic Taiwan. Although the specific term ‘preventative strike’ might not enter into her lexicon, it is possible to imagine the child, whose knowledge is thus limited, thinking that if democratic Taiwan were threatened by China, the UK would (possibly or probably) launch a strike on China to protect it, much as the UK had done to help democracy in Iraq. In contrast to the child, readers of this journal and scholars who study the world more thoroughly have factual information (e.g. about the relative military and economic capabilities of the UK and China) and hold some cause-and-effect principles (such as that states do not usually initiate actions that leaders understand will have an extremely high probability of undercutting their power with almost no chances of success). Anyone who has adequate knowledge of world politics would predict that the UK will not launch a preventive attack against China . In the real world, China knows that for the next decade and well beyond the UK will not intervene militarily in its affairs. While Chinese leaders have to plan for they do not have to structure forces geared to defend against specifically UK forces and do not have to conduct many likely — and even a few somewhat unlikely — future possibilities, they do not have to plan for various implausible contingencies: diplomacy with the UK in a way that would be required if such an attack were a real possibility. Any rational decision-maker in China may use some cause-and-effect (probabilistic) principles along with knowledge of specific facts relating to the Sino-British relationship to predict (P2) that the UK will not land its forces on Chinese territory — even in the event of a war over Taiwan (that is, the probability is very close to zero). The statement P2 qualifies as a prediction based on DEF above and counts as knowledge for Chinese political and military decision-makers. A Chinese diplomat or military planner who would deny that theory-based prediction would have no basis to rule out extremely implausible predictions like P2 and would thus have to prepare for such unlikely contingencies as UK action against China. A reflexivist theorist sceptical of ‘prediction’ in IR might argue that the the critic’s temptation to dismiss its value stems precisely from the fact that it is so obviously true. The value to China of knowing that the UK is not a military threat is significant. The fact that, under current conditions, any plausible causeChina example distorts the notion by using a trivial prediction and treating it as a meaningful one. But and-effect understanding of IR that one might adopt would yield P2, that the ‘UK will not attack China’, does not diminish the value to China of knowing the UK does not pose a military threat. A critic might also argue that DEF and the China example allow non-scientific claims to count as predictions. But we note that while physics and chemistry offer precise ‘point predictions’, other natural sciences, such as seismology, genetics or meteorology, produce predictions that are often much less specific; that is, they describe the predicted ‘events’ in broader time frame and typically in probabilistic terms. We often find predictions about the probability, for example, of a seismic event in the form ‘some time in the next three years’ rather than ‘two years from next Monday at 11:17 am’. DEF includes approximate and probabilistic propositions as predictions and is thus able to catagorize as a prediction the former sort of statement, which is of a type that is often of great value to policy-makers. With the help of these ‘non-point predictions’ coming from the natural and the social sciences, leaders are able to choose the courses of action (e.g. more stringent earthquakesafety building codes, or procuring an additional carrier battle group) that are most likely to accomplish the leaders’ desired ends. So while ‘point predictions’ are not what political leaders require in most decision-making situations, critics of IR predictiveness often attack the predictive capacity of IR theory for its inability to deliver them. The critics thus commit the straw man fallacy by requiring a sort of prediction in IR (1) that few, if any, theorists claim to be able to offer, (2) that are not required by policy-makers for theory-based predictions to be valuable, and (3) that are not possible even in some natural sciences.15 The range of theorists included in ‘reflexivists’ here is very wide and it is possible to dissent from some of the general descriptions. From the point of view of the central argument of this article, there are two important features that should be rendered accurately. One is that reflexivists reject explanation–prediction symmetry, which allows them to pursue causal (or constitutive) explanation without any commitment to prediction. The second is that almost all share clear opposition to predictive social science.16 The reflexivist commitment to both of these conclusions should be evident from the foregoing discussion. AT: NO MODELING US organ policy is empirically modeled internationally Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25) The principle that organs for transplantation are gifts to the community rather than market commodities influenced other countries as they established their own programs and laws.17 The U.S. approach was fully accepted in Western Europe, where it had been practiced from the beginning of kidney transplantation; policies in Europe were grounded in the human-rights principles that underlie bioethics legislation and in the need for cooperation across national borders.18 Elsewhere, however, in countries where the rule of law was less strong, where human rights were not enforced, where economic inequality was more pronounced, and where healthcare systems were not set up to support deceased donation, transplantation depended on living donors, particularly poor and marginalized persons, whose agreement to “donate” could be bought or coerced.19 By the mid-1980s, reports began emerging, principally from Asia and Latin America, of surgeons providng wealthy patients (both indigenous and foreign) with transplanted kidneys that had been purchased from impoverished people.20 In 1987, at the urging of several member states, the Fortieth World Health Assembly took note of the problem and requested the Director-General of the World Health Organization (WHO) “to study, in collaboration with other organizations concerned, the possibility of developing appropriate guiding principles for human organ transplants.”21 The Guiding Principles on Human Organ Transplantation (Guiding Principles), which were approved by the Forty-Fourth World Health Assembly in May 1991, established a preference for deceased over living donors and, among living donors, a preference for related over unrelated donors, and proclaimed globally the model of voluntary, unpaid donation of organs from living and deceased donors that had provided the ethical foundation for transplantation in the United States for the previous four decades.22 China would specifically model and it has a worldwide effect on organ markets Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25) The arguments just presented provide sound reasons not to abandon NOTA’s prohibition on exchanging organs for “valuable consideration,” but if more reasons are needed, the adverse effects of such a change on the newly adopted prohibitions in a number of countries constitute additional strong grounds for maintaining the present prohibitions in North America and Europe. A brief review of developments in China—where recent progress in replacing commercial organ procurement with a voluntary system that relies on uncompensated deceased and living-related donors remains precarious and very dependent on the combined efforts of many entities, from WHO to professional and other nongovernmental organizations—illustrates this point. The omission of China from the earlier catalogue of transplant hotspots that have recently undergone reforms may have seemed puzzling given that both its number of organ “donations” and its number of transplant tourists dwarf activity in every other county.167 Moreover, the manner in which almost all of these organs have been obtained and distributed transgresses international norms even more markedly than the often-criticized methods used in other countries. Finally, the push and pull of the government’s attempts to bring its practices into alignment with those norms is perhaps the most contested of any national efforts at reform. Details about China’s organ transplantation are controverted, but for nearly thirty years it has had the most unusual program for obtaining organs of any nation. For a country that is very large and diverse in territory and population and that moved rapidly up the HDI during this period,168 the rate of organ transplantation in China is not high: The combined living and deceased-donation rate for all organs probably remains under twenty per million population.169 But in absolute numbers (better than 10,000 transplants per year, with a very high percentage going to foreign recipients170), the extent of China’s program and its impact on the development of transplant programs in other countries is potentially immense. The basis for the Chinese transplant program has been the Temporary Rules Concerning the Utilization of Corpses or Organs from the Corpses of Executed Criminals, secretly issued by the government in 1984.171 Though criticized in the past five years by Chinese officials themselves,172 the rules are still on the books and account for the huge volume of deceaseddonor transplantation in China every year, which generates many millions of dollars in revenue.173 Under these rules, organs from executed prisoners may be used for medical purposes if no one claims the body, if the prisoner slated for execution volunteers to have his corpse so used, or if the family consents after the execution.174 The use of executed prisoners would raise concerns—most centrally, about validity of any consent and about conflicts of interest—even were there no reason to have doubts about the manner in which prisoners are condemned to death. But of course human-rights advocates have also raised grave doubts about the fairness of the Chinese justice system. First, it appears that the demise of organ donors may be timed for the convenience of waiting recipients with whom each executed prisoner is well matched, thus implying that executions are being carried out solely to benefit organ recipients.175 Second, allegations have been made (and denied by the government) that political, ethnic, and religious dissidents, such as ethnic Uighurs in western China and the practitioners of the outlawed Falun Gong discipline, constitute a disproportionate number of the persons targeted for execution.176 The practice of taking organs from executed prisoners has been repeatedly criticized by groups such as Amnesty International and Human Rights Watch but, even after Deputy Minister of Health Huang Jiefu publicly acknowledged it in 2006 and stated that the time had come for Beijing to adopt a sustainable basis for organ donation in line with international norms, the practice continues, albeit it on a reduced scale.177 In March 2013, at the start of the major People’s Congress to choose new leaders for the People’s Republic, Dr. Huang announced that China would completely cease the practice of using executed prisoners within two years.178 At a meeting in Hangzhou in October 2013, Bin Li, chairperson (equivalent to minister) of the National Health and Family Planning Commission (NHFPC),179 announced a five-point plan that committed the government and all hospitals to “open and transparent” organ procurement and allocation and other standards to replace the use of executed prisoners with living related donors and patients diagnosed dead on circulatory or neurology grounds.180 This plan was then formally endorsed as the Hangzhou Resolution by the Chinese Transplant Congress, which met in that city on November 1–2, 2013, at which time representatives of 38 of the nation’s leading transplant hospitals signed the resolution and pledged to comply with the interim regulations promulgated by the NHFPC in August 2013, in particular to cease using executed prisoners as organ donors.181 However, the government has not acted against transplant centers that continue to rely on organs from executed prisoners,182 but has instead aimed to end transplants to non-Chinese citizens (although the allowance for overseas Chinese citizens to return to China for a transplant has apparently become a loophole for medical centers that use Chinese names for their foreign patients).183 Besides China’s singularity in terms of the scope of its commercial transplant program and the source of the organs, the struggle among various forces over the character of the new organtransplant system that it is now constructing has enormous implications not only for China but for the whole world. On the one side are organ procurers who have linked the civilian and military prisons with the hospitals where transplants have been performed; their ability to resist change has been aided by the financial power they wield, the regional distribution of influence and power within the bureaucracy, and the difficulties facing the national health ministry in organizing an organ-procurement system to replace the one that has relied on executed prisoners. On the other side are Chinese transplant professionals, supported by the DICG and international organizations such as WHO, who urge the government to adopt reforms that will bring them into line with international ethical norms for transplantation. These outside groups have offered guidance to the government in crafting appropriate legislation to provide for the use of donors who die from loss of neurological or circulatory functions while under medical care and to condition licenses for hospitals’ transplant programs on following the new rules.184 Foreign transplant professionals have also been involved in programs to train the staff of organprocurement organizations on how to organize a fair and transparent system and to work with physicians and potential donors (individuals and the families of the deceased) in implementing the regulations.185 The DICG has also sought to bring negative as well as positive reinforcement to incentivize Chinese transplant professionals to adhere to international standards by encouraging academic medical journals to place “barriers to the publication of data that involve executed prisoners,” by advocating for professional societies to prevent “the presentation at their meetings of clinical research involving executed prisoners,” and by urging pharmaceutical companies to limit “clinical trials in China for the same reason.”186 Even the Chinese who employ international norms to push for change within their own system do not want their country to be seen as bowing to outside pressure. They point out that Western countries built their transplant programs slowly and that a total transformation cannot reasonably be expected to occur in a large nation that is simultaneously undergoing huge technical, economic, and demographic changes, and they are reluctant to totally renounce “the executed prisoner’s right to donate organs.”187 Such a concept may seem so ludicrous as to be offensive, but how much freer is the choice exercised by bonded laborers in Pakistan or slum dwellers in Delhi or Manila when they accept a small sum to become kidney donors? 2NC UNIQUENESS WALL The Declaration of Istanbul is substantially decreasing organ trafficking and transplant tourism now – also increases international supply Danovitch et al, 13 - David Geffen School of Medicine at UCLA, Los Angeles, CA (Gabriel, “Organ Trafficking and Transplant Tourism: The Role of Global Professional Ethical Standards —The 2008 Declaration of Istanbul” Transplantation. 2013 Jun 15;95(11):1306-12. doi: 10.1097/TP.0b013e318295ee7d. By 2005, human organ trafficking, commercialization, and transplant tourism had become a prominent and pervasive influence on transplantation therapy. The most common source of organs was impoverished people in India, Pakistan, Egypt, and the Philippines, deceased organ donors in Colombia, and executed prisoners in China. In response, in May 2008, The Transplantation Society and the International Society of Nephrology developed the Declaration of Istanbul on Organ Trafficking and Transplant Tourism consisting of a preamble, a set of principles, and a series of proposals. Promulgation of the Declaration of Istanbul and the formation of the Declaration of Istanbul Custodian Group to promote and uphold its principles have demonstrated that concerted, strategic, collaborative, and persistent actions by professionals can deliver tangible changes. Over the past 5 years, the Declaration of Istanbul Custodian Group organized and encouraged cooperation among professional bodies and relevant international, regional, and national governmental organizations, which has produced significant progress in combating organ trafficking and transplant tourism around the world. At a fifth anniversary meeting in Qatar in April 2013, the DICG took note of this progress and set forth in a Communiqué a number of specific activities and resolved to further engage groups from many sectors in working toward the Declaration’s objectives. By the middle of the first decade of the 21st century, the sale of human organs for transplantation, first reported in the 1980s (1), had metamorphosed from a hidden and limited activity in the back streets of a handful of developing countries to a widespread, and sometimes brazen, activity that involved potential recipients traveling to clinics around the world to receive a kidney from poor, and poorly paid, “donors.” Trafficking in organs and the persons from whom they were removed in India, Pakistan, Egypt, the Philippines, and Eastern Europe—or executed prisoners in China—came to have a pervasive, malign influence on transplant activities in many parts of the world (2). Growing numbers of transplant candidates with personal wealth or support from governments or health insurers were flying from the Gulf states, Israel, Europe, and North America to Eastern Europe, Asia, South Africa, and Latin America to obtain kidney transplants at for-profit hospitals and clinics they had found through brokers or online advertisements. The growing rate of kidney sales over the preceding 20 years was driven by the needs of wealthy or well-insured recipients. The rationale for allowing the practice was provided by three groups: (a) philosophers who think that “donors” should be allowed to exercise their autonomy by selling their organs; (b) believers in neoclassic economics, who think that treating organs as a market commodity will increase the supply; and (c) nephrologists and surgeons whose eagerness to serve their patients’ needs have led them to flirt with “regulated markets” in kidneys and other organs (3). None of these positions stand up in the face of evidence or professional ethical standards. As to the first, decades of experience have shown that the sellers of organs everywhere are the poor or the vulnerable, whose actions reflect financial desperation and ignorance, not autonomous agency. The central bioethical principles of beneficence and justice are equally abused by organ sales, which crowd out altruistic donations, leave paid donors worse off, and exploit the poor to benefit the rich (4). Second, the transplant rates in countries with voluntary, unpaid systems exceed those in countries where organs are sold, and the number of available organs actually increases when sales are combated because the act of donating ceases to be mercenary and becomes a human gesture of solidarity and generosity. Third, it is wishful thinking to believe that creating a marketplace will provide more organs for their patients. Reliance on payments—including financial incentives and comparable monetary “rewards” for donors, or for families in the case of deceased donation— paints organ donation with the brush of financial vulnerability and sullies respect for human dignity. Unfortunately, the willingness of people in the third category to embrace the first two arguments has lent credibility to physicians and hospitals in developing countries that have profited financially from transplanting organs from the poor into wealthy and well-insured patients. By promoting explicit or disguised organ commercialism, these latter actors exploit the arguments of people in the third category who have called for “experimenting” with financially motivated organ donation (3), in an attempt to divert international attention from the history of destitution, injuries, and even death among paid organ donors who have been left to live with the legacy of exploitation. The DOI has substantially decreased organ trafficking Danovitch et al, 13 - David Geffen School of Medicine at UCLA, Los Angeles, CA (Gabriel, “Organ Trafficking and Transplant Tourism: The Role of Global Professional Ethical Standards —The 2008 Declaration of Istanbul” Transplantation. 2013 Jun 15;95(11):1306-12. doi: 10.1097/TP.0b013e318295ee7d. Since the publication of the DoI, organ trafficking and transplant tourism, which have their greatest effect in developing countries, have been inhibited, as has the broader phenomenon of organ commercialism. Success in combating organ trafficking has been aided by the implementation of the protocol issued in 2000 by the United Nations as part of its effort to halt transnational organized crime, the United Nations Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, in which the “removal of organs” is recognized as a key purpose of human trafficking (14). In 2009, the Council of Europe and the United Nations jointly produced a study on organ trafficking and trafficking in human beings for the purpose of the removal of organs that concluded that specially adapted means should be used to combat each, including emphasizing voluntary donation and the absence of financial gain from the human body or its parts (15). In the UK, the Nuffield Council of Bioethics report on organ donation, to which the DICG contributed, concluded that altruism should continue to play a central role in ethical thinking about donation (16). In 2011, Spain made special mention of the DoI when modifying its Penal Code to provide sanctions for trafficking in organs or people for the purpose of the removal of organs (17). Further, in 2012, the Coalition for Organ Failure Solutions urged the U.S. Congress to incorporate human trafficking for organ removal under the rubric of the Trafficking Victims Protection Act (18). Such a measure need not interfere with a related practice, defined by the DoI as “travel for transplant,” such as occurs when a living related donor resides in a different country than his or her planned recipient or a recipient– donor pair have to cross a border to access transplantation expertise that is not available in their own community (7). Finally, in May 2010, the World Health Assembly (WHA) adopted a resolution encouraging the creation of systems of unpaid donation of organs from deceased and living donors and endorsing the updated WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, which restate the 1991 principles and add two aimed at vigilance and safety in transplantation and at ensuring transparency in organ procurement and allocation. These steps by the WHA have encouraged countries to cooperate with one another and the DICG in ending all forms of organ commercialism (19). This alignment of activities is assisted by the status of TTS as a nongovernmental organization in official relations with the WHO. WINDS OF CHANGE In the past 5 years, major changes in policies and practices have occurred in countries that had previously been centers of organ trafficking and transplant tourism. Six of these former “hotspots” merit special mention because of the dramatic changes in policies and practices that have occurred—and are continuing—in each. Pakistan Over the past four decades, transplant programs in a number of Pakistani cities have performed many thousands of commercial transplants for foreigners using kidneys from the poor from villages throughout the country. In 2010, leaders of the Sind Institute of Urology and Transplantation in Karachi, backed by the DICG, led a successful effort for a new law criminalizing organ sales. The number of illegal transplants has since fallen, but constant vigilance must be exercised to prevent its resumption by the surgeons and hospitals that stand to profit. The DICG members have identified several illicit programs, which have been closed and prosecuted (20). India India was identified as a common destination for commercial transplants and transplant tourism in 1980s and 1990s. The Indian Parliament outlawed commercial transplants and recognized the concept of brain death through the 1994 Transplantation of Human Organs Act (21). The number of such transplants fell after the enactment of this law, although there remained widely publicized cases of its abuse. The law, however, allowed unrelated transplants motivated by love and affection provided these were cleared by a statutory “Authorization Committee” set up by the states. This committee itself provided an avenue for abuse (22). In 2008, after the adoption of the DoI and the revised WHO Guiding Principles, the Indian government amended the Transplantation of Human Organs Act (21). The role and functioning of the authorization committees has been better defined, tests to ascertain relationship were prescribed, greater caution was suggested to prevent exploitation of females, a mandatory requirement for all foreign nationals to obtain clearance from the Authorization Committee and embassies of their home countries has been introduced, and the penal provisions stiffened. At the same time, the Government has put into place a mechanism to promote deceased donations. In the state of Tamil Nadu with a population of more than 70 million, a private hospital–public hospital partnership promoting deceased-donor transplantation has effectively eliminated commercialization in a manner that can serve as a model for other regions of South Asia and developing countries (23). China Chinese organ transplant activities have global implications. For the last decade or more, Chinese hospitals, aided by Internet advertising, have been major destinations for wealthy or well-insured transplant tourists from around the world. The conversion of the body of an executed prisoner into cash through sale of its organs and the exploitation of living kidney donors for foreign patients not only engenders profound ethical concerns but also comes at the expense of the needs of the Chinese population. The DoI specifically addresses the unacceptable nature of the Chinese practice of “donation by execution.” The DICG, the TTS (24), and other nongovernmental organizations, including Amnesty International and Human Rights Watch, have taken an unequivocal stance against this practice while promoting ethically acceptable alternatives (25). As urged by the DICG, several academic journals have placed barriers to the publication of data that involve executed prisoners, societies of transplant professionals have prevented the presentation at their meetings of clinical research involving executed prisoners, and pharmaceutical companies have limited clinical trials in China for the same reason. The firm stance by the DICG and other international groups, as well as the policies promoted by the WHO, are having notable effects. High-ranking Chinese government officials have themselves brought attention to the lack of acceptance by the international community of the practice of using organs from executed prisoners and of the corruption and commercialization that characterize living and deceased donation in China (26). Authorities have closed dozens of transplant programs, which violated new rules that severely limit transplant tourism. In the next cycle of reauthorization, Chinese transplant programs will be required to have in place alternative programs to the use of organs from executed prisoners (27). Progressive changes in China will have significant implications for countries from which a substantial number of transplant recipients have traveled in recent years to China to purchase organs. Nonethnic Chinese have been known to use assumed names and identities presumably to bypass the Chinese law that officially criminalizes such activities. The Philippines Fueled by poverty in the slums of Manila and an extensive network of organ brokers, the Philippines was a well-known destination for transplant tourists during the past decade; even programs that provided transplants for domestic patients relied on the profits from transplanting foreign patients. A presidential directive, issued on April 30, 2008, at the start of the Istanbul Summit, established a ban on foreign recipients receiving kidneys from Filipino living donors. Supplemental rules and regulations for the implementation of the organ trafficking provision of the Anti-Human Trafficking Law went into effect in June 2009 (28). The annual number of foreign transplant recipients fell from 531 in 2007 to 2 in 2011, and the number of deceased-donor transplants has increased threefold in the same period (29). Egypt Since the 1980s, Egypt has been the main locale for organ trafficking and transplant tourism in the Middle East (2). In February 2010, representatives of the WHO and the DICG obtained commitments from Egyptian transplant leaders and policymakers to end these practices; this culminated in the passage of the landmark Law on Human Organ Transplantation, which prohibits and penalizes organ trafficking and permits deceased donation in accord with the WHO Guiding Principles and the DoI (30). Unfortunately, political changes have shifted the focus, and most centers appear to be undertaking commercial organ transplants, including the use of trafficked donors, despite the 2010 law (31, 32). The reporting of Egyptian transplant data to a new registry under the auspices of the Middle Eastern Society of Transplantation may provide a much-needed source of transparency. Colombia and Latin America In the first decade of the 21st century, Colombia was a major provider of deceased-donor organs for wealthy foreigners. A concerted effort by the government to stop this practice and direct organs to citizens of Colombia and neighboring countries, through regional governmental agreements, led to a fall in transplants to noncitizens from 16.5% of the total (200 transplants) in 2005 to 1.37% (16 transplants) in 2010 (33). The presidents of every Latin American Society of Nephrology have endorsed the DoI (11), and the Society of Transplantation of Latin America and Caribbean (STALYC), during the first Latin American Forum in Ethics and Transplantation adopted the “Document of Aguascalientes”, which closely parallels the DoI (34). In February 2012, Brazil became the first country to include specific reference to the DoI in its national regulations regarding transplanting organs into nonresidents (35). AT: REGULATIONS SOLVE Our ev is more qualified and every regulated market has lapsed into predatory behavior Danovitch and Delmonico 2008 – *Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA; **Harvard Medical School, Massachusetts General Hospital Transplant Center (Gabriel M. and Francis L., Current Opinion in Organ Transplantation, 13:386–394, “The prohibition of kidney sales and organ markets should remain”) The idea that a commercialized system of organ sales can supplement or even replace the noncommercial donation system that has been the core of transplant practice since its inception is not new. Kidneys and livers are bought and sold in several regions of the world, and though it might be tempting to think that the evils that are associated with such commercialization will necessarily escape a ‘regulated’ market in the United States, we will show that such an intention is not attainable. The market experiments done in other countries that have attempted to ‘regulate’ the market for organs have been unsuccessful in fixing prices, excluding the activities of brokers or addressing the health of paid donors. We will review the current international reality of organ sales both of the proposed ‘regulated’ and existing ‘unregulated’ variety and consider how a commercialized system would impact solid organ transplantation in the United States. The commercialization of organ donation is fraught with danger: danger to paid donors; danger to their recipients; danger to patients in need of nonrenal transplants from deceased donors; and danger to the role of transplant professionals as stewards of the whole organ transplant endeavor. The trust of the public and the legacy of transplantation are at risk if organ markets are sanctioned in the United States or the rest of the world. Global nature of supply means their regs cause a race to the bottom J. Mark Raven-Jackson, 2K ; CBS Business, LawNow, Oct-Nov, 2000; Xenotransplantation: a regulatory beast of burden, http://findarticles.com/p/articles/mi_m0OJX/is_2_25/ai_n25027587/pg_4/ All regulatory efforts will be in vain if other nations end up adopting weaker regulations or no regulations at all. Countries that adhere to these lower standards have the potential of becoming xeno-havens for unscrupulous surgeons and researchers. Daniel Salomon, a member of It is complicated for nations to regulate xenotransplantation in order to protect the xenotransplant recipient, public health, and donor animals. the board of the American Society of Transplant Physicians, a body that has long waged war on the trafficking of human organs in developing countries, states that the prospects of xeno-havens scares him. Salomon states that the regulations that are now being developed in industrialized countries will create a strong incentive for poorer countries to traffic in xenotransplants. The big risk is that recipients will receive disease laden organs from endangered primates and there will be no way to monitor their movement or interaction with the general public. Organ sales inevitably expand global trafficking—regulations will fail and states will use permissive US laws to justify lax regimes—turns case Danovitch and Delmonico 2008 – *Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA; **Harvard Medical School, Massachusetts General Hospital Transplant Center (Gabriel M. and Francis L., Current Opinion in Organ Transplantation, 13:386–394, “The prohibition of kidney sales and organ markets should remain”) Organ sales entail organ trafficking The following definition of organ trafficking is derived from the U nited Nations Trafficking in Persons (http://www.unodc.org/unodc/en/trafficking_human_ beings.html). Organ trafficking entails the recruitment, transport, transfer, harboring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation by the removal of organs, tissues or cells for transplantation. The abovementioned United Nations definition of organ trafficking captures the various exploitative measures used in the processes of soliciting a donor in a commercial transplant. The reason to oppose organ trafficking internationally is the global injustice of using a vulnerable segment of a country or population as a targeted source of organs (vulnerable defined by social status, ethnicity, sex or age). In Pakistan, bonded laborers are used as the source of kidneys [3]. Exploitation is at the core of organ sales whether it is intended to be ‘regulated’, (or as has been the Iranian experience) or not [4]. The proponents of organ sales in the United States are not obviously advocating the use of a bonded laborer as a donor source. However, they acknowledge that the poor person will be the likely target for appeals to sell a kidney. The views of proponents of organ sales in the United States have been a reference for other countries such as Pakistan and the Philippines to propel those unethical programs that use the bonded laborers and slum victims as the vendor sources. Regulations fail- global experience proves circumvention Scheper-Hughes, 3 – UC Berkeley Medical Anthropology professor [Nancy, Director of Organs Watch, Francis L. Delmonico, Director of the Renal Transplantation Unit at Massachusetts General Hospital, the medical director at the New England Organ Bank, and Professor of Surgery at Harvard Medical School, "Why We Should Not Pay for Human Organs," Zygon, 38(3), Sept 2003, www.homeworkmarket.com/sites/default/files/why_we_should_not_pay_for_human_organs. pdf, accessed 8-27-14] Proponents of organ sales suggest that a distribution system regulated with government oversight would prevent these widely known abuses from occurring, at least in the United States. However, the debate then moves to another arena for public policy makers to consider. Would a system regulated by the Department of Health and Human Services (DHHS) accomplish its objectives and become the only route of organs for payment? This is doubtful in view of the futility of regulated control of donor payments suggested by current practice elsewhere. The global market sets the value based on social, economic, and consumer-oriented prejudices, such that in todays kidney market an Indian kidney fetches as little as $ 1,000, a Filipino kidney $ 1,300, a Moldovan or Romanian kidney $2,700, while a Turkish seller can command up to $10,000 and an urban Peruvian as much as $30,000 (Scheper-Hughes 2002a, 73; 2002b). Brokering in the United States would likely be no different. If the current policy of prohibition of organ sales was rescinded, there would be little justification, legally or ethically, to prevent donors from circumventing the DHHS system and using the Internet to solicit a better price. A regulated system would either have to outlaw Internet bidding and set a controlled price or would have to continuously modify the price to outbid Internet brokers and to keep up with emerging kidney markets elsewhere. It’s far more likely no regulation would emerge because it would be seen as a barrier to effective sales Capron, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD” LAW AND CONTEMPORARY PROBLEMS Vol. 77:25) The alternative—which true believers in inducements should embrace— would be a genuine market with prices set by the forces of supply and demand that reflect the point at which individual sellers would part with an organ and individual buyers would part with their money to obtain one. The market would qualify as “regulated” because of other non-price-based rules aimed at protecting donors against abuses, such as requirements regarding postoperative care of organ donors. On the demand side, reliance on a true market would effectively upend the present allocation system, because successful buyers would be those who not only place a higher value on receiving an organ transplant but also have a greater ability to pay (whether from their own wealth or generous medical-insurance coverage). The result would be differentiation not only among the purchasers, with willingness to pay determining one’s place in line, but also among the sellers, with the most desirable organs commanding a higher price. Although some market proponents might not be bothered by this outcome, others have suggested that it should be avoided by keeping organ donors and recipients anonymous to each other and by having the latter pay into the fund that supports the organ-procurement system rather than directly to their donor.118 Yet such a system would produce both market inefficiencies and strategies to get around them, of the sort previously described.119 On the supply side of a true market in organs, one must begin with the question of whether, in this era of trade liberalization, there would be any ground for restricting donation to domestic sellers. The aversion in certain circles to letting people from other countries come to the United States to work really has no relevance to organ sales, because the persons involved would be coming into the country solely as the delivery vehicles for their kidneys (or liver lobes), and would return to their country of origin once their cargo had been unloaded. This was indeed the vision of Dr. Jacobs, whose projected International Kidney Exchange, Ltd. was intended to be a setting where U.S. patients could exchange their funds for the kidneys of willing donors from Latin America.120 But why should such an institution not have a more global reach than that, when it is already apparent that thousands of Pakistanis, Indians, Filipinos, and other impoverished “would be vendors” of the world, when allowed “to decide for themselves about their own best interests,”121 are willing to exchange a kidney for a relatively modest sum of money? The argument for allowing payments for organs rests on the principle of utility (that the greatest good consists in saving or, in the case of kidney transplants, extending and improving, human life) and the principle of liberty (that freedom of contract must be protected). Yet these principles provide no grounds for erecting impediments to patients, physicians, or indeed health systems seeking potential organ sellers anywhere in the world. As philosopher Janet Radcliffe Richards argues, “If it is presumptively bad to prevent sales altogether, because lives will be lost and adults deprived of an option some would choose if they could, it is for the same reason presumptively bad to restrict the selling of organs.”122 Thus, if restrictions are to be placed on markets, principles other than utility and liberty must justify them. Such justification can be found in the three basic principles of medical ethics: justice, beneficence, and autonomy.123 Any regulations they create are easy to circumvent Capron et al, 14 - University Professor and Scott H. Bice Chair in Healthcare Law, Policy, and Ethics, University of Southern California (Alexander, “Organ Markets: Problems Beyond Harms to Vendors”, American Journal of Bioethics, October, Volume 14, Number 10, 2014) Further, in all settings where kidneys have been market commodities, the act of selling a kidney is seen as debasing, something that a person would do only if he or she had no other means of survival. A regulated market won’t change that. Indeed, it is likely that means would arise to circumvent the intended limitations on the incentives, such as financial entrepreneurs arranging for poor kidney sellers to obtain a lesser sum in cash in exchange for the money deposited into a retirement account for them. From the viewpoint of transplant programs, this would have the advantage of producing more kidneys (since in all societies the poor are the readiest source of organs), but very unjustly and by making a mockery of the notion of a “regulated” market. AT: LINK TURN And – err neg on the link a. Our ev reflects the consensus of international studies based on legal and unregulated organ markets – their ev is conjecture based on economic theory Koplin, 14 – PhD candidate in bioethics at Monash University, member of the Declaration of Istanbul Custodian Group, managing editor of ERAS Journal, (Julian, “Assessing the Likely Harms to Kidney Vendors in Regulated Organ Markets” The American Journal of Bioethics, 14(10): 7–18, 2014) Almost every study that has asked the question has found that the majority of vendors regret selling a kidney and/or would not recommend doing so to others (Awaya et al. 2009; Goyal et al. 2002; Mendoza 2010a, 380; Moazam et al. 2009, 22–23; Moniruzzaman 2010, 320; Naqvi et al. 2007, 936–937; Tanchanco et al., cited in Padilla 2009, 122; Zargooshi 2001b). Moreover, a study of 100 Iranian donors (97 of whom were vendors) found that 76% were in favor of banning kidney sales (Zargooshi 2001a). According to vendors’ own accounts, selling a kidney left them worse off physically, psychologically, socially, and financially. In the face of this body of research, and in the absence of compelling reasons to believe that such outcomes are entirely attributable to black-market abuses, the ubiquitous claim that regulated systems of kidney selling would improve vendors’ well-being lacks evidential warrant. The available research, despite its limitations, suggests the opposite: that vendors will usually experience a range of significant harms that ultimately leave them worse off than before the sale. Given the limitations of existing research on vendor outcomes, and particularly the scarcity of controlled studies in regulated contexts, it could be argued that this article’s conclusion is premature—that instead of relying on evidence from existing markets, we should conduct pilot programs and clinical trials (Hippen and Matas 2009). My argument here, however, is limited to what conclusions we should draw from the available literature; it therefore neither rules out nor entails support for conducting clinical trials. Like all empirical arguments, it is open to revision in the light of new research. However, unless new evidence is produced, market proponents’ confidence that a regulated market in kidneys would benefit vendors is unwarranted. b. a purely economic approach to organ sales overlooks the cultural and social factors that increase exploitation. Even if the plan is effective in the US – the global effects of their model spur massive exploitation Hentrich, 12 – independent researcher (Michael, “Health Matters: Human Organ Donations, Sales, and the Black Market” http://arxiv-web3.library.cornell.edu/abs/1203.4289 The implications of permitting the sale of organs also differs by country based on levels of wealth and cultural norms. The same policy decisions made in the United States and Kenya would have vastly different results. Global policy decisions about organ transplant made purely on a homogenous economic analysis could well be misguided by failing to account for cultural norms and differing social conditions (Kaserman 2002). In developing countries the formal institutions involved with organ transplant are also less advanced. There are fewer doctors in the related areas and fewer transplant organizations through which to organize a legal market. These conditions combine to leave developing countries open to poorly regulated markets, abuse of donors and sellers, and the existence of a black market for organs obtained in ways that may not be fair and legal (Goodwin 2006). YES DISEASE EXTINCTION Burnout is wrong Karl-Heinz Kerscher 14, Professor, “Space Education”, Wissenschaftliche Studie, 2014, 92 Seiten The death toll for a pandemic is equal to the virulence , the deadliness of the pathogen or pathogens, multiplied by the number of people eventually infected. It has been hypothesized that there is an upper limit to the virulence of naturally evolved pathogens. This is because a pathogen that quickly kills its hosts might not have enough time to spread to new ones, while one that kills its hosts more slowly or not at all will allow carriers more time to spread the infection , and thus likely out-compete a more lethal species or strain. This simple model predicts that if virulence and transmission are not linked in any way, pathogens will evolve towards low virulence and rapid transmission . However, this assumption is not always valid and in more complex models, where the level of virulence and the rate of transmission are related, high levels of virulence can evolve. The level of virulence that is possible is instead limited by the existence of complex populations of hosts, with different susceptibilities to infection, or by some hosts being geographically isolated. The size of the host population and competition between different strains of pathogens can also alter virulence. There are numerous historical examples of pandemics that have had a devastating effect on a large number of people, which makes the possibility of global pandemic a realistic threat to human civilization. We cognitively underestimate disease Patrick S. Roberts 8, fellow with the Program on Constitutional Government at Harvard and assistant professor with the Center for Public Administration and Policy at Virginia Tech, January, Review of Richard Posner’s “Catastrophe: Risk and Response,” Homeland Security Affairs, Volume 4, No. 1 Most people have difficulty thinking about abstract probabilities as opposed to events they have capacity is limited, and startling events such as the attacks of September 11 trigger our attention. But evaluating risk requires paying attention to what we do not see. There has been surprisingly little attention in the popular media given to pandemic flu, even though influenza killed approximately twenty million people in 1918-1919. The disease has no cure, and vaccines are difficult to produce because of the mutability of the virus. People from all walks of life pay greater attention to issues in recent memory and tend to give greater weight to confirmatory evidence; the cumulative effect is to under- prepare for catastrophe. observed. Human mental
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