Taboo Trades

Kidneys, Stakes, & Plasma with James Stacey Taylor

November 07, 2023 Kim Krawiec Season 4 Episode 5
Taboo Trades
Kidneys, Stakes, & Plasma with James Stacey Taylor
Show Notes Transcript

On today’s episode, the amazing James Stacey Taylor, a Professor of Philosophy at The College of New Jersey, joins me and UVA Law 3L Liam Bourque. Taylor has written over 100 academic articles and five books. He’s with us today to discuss excerpts from two of those books: Bloody Bioethics: Why Prohibiting Donor Compensation Harms Patients and Wrongs Donors, and Stakes & Kidneys: Why Markets in Human Body Parts Are Morally Imperative


Show Notes

Taylor, James Stacey. Stakes and kidneys: why markets in human body parts are morally imperative. Taylor & Francis, 2017.


Taylor, James Stacey. Bloody bioethics: Why prohibiting plasma compensation harms patients and wrongs donors. Routledge, 2022.


Blood and Repugnant Transactions with Nicola Lacetera & Mario Macis (Season 1, Episode 4)


Plasma with Peter Jaworski (Season 1, Episode 1)


[00:00] James Stacey Taylor: I've seen a similar response to academics who are paid large amounts of money. Now, there's not many of them, but if you're somebody like, say, Michael Sandel or, oh, Francesco Gina at Harvard who's recently been revealed she has a very large salary, and some of the discussion of those people, I think, has the same slant as it does with respect to kidney vendors. It's like, why are you doing this? Why are you engaging this research? Well, it's obvious because Harvard's paying you a million dollars a year. So there's no real understanding. Even among other academics who I think are largely motivated by jealousy against people who have very high salaries, there's no real understanding. It's like, that high salary is a bonus. It's like a really nice bonus, but you're getting to pursue things which you're really interested in. So it might be that once we move beyond a certain amount of money, people say, well, that's such a large amount of money, you must just be doing it for the money, completely ignoring the fact that for many people, it might be, I'm really lucky. I'm getting paid a large amount of money, and I'm getting to do what I love.

[01:16] Kim Krawiec: Hey. Hey, everybody. Welcome to the Taboo Trades podcast, a show about stuff we aren't supposed to sell, but do anyway. I'm your host, Kim Kravick. On today's episode, I'm joined by the amazing James Stacey Taylor, a professor of philosophy at the College of New Jersey. Taylor has written over 100 academic articles and five books. He's with us today to discuss excerpts from two of those books. Bloody Bioethics why prohibiting Donor Compensation, Harms Patients and Wrongs Donors and Stakes in Kidneys why markets and human body parts are morally imperative. James, hey, welcome.

[02:06] James Stacey Taylor: Thank you for having me.

[02:07] Kim Krawiec: Let's start by Liam giving a brief introduction of yourself both for James and for the podcast audience.

[02:13] Liam Bourque: All right. Hello, Professor James. I'm Liam. I'm a 3L at UVA, and I'm excited to have you on the podcast today. Thank you for coming, and we look forward to hearing your thoughts on kidney donation or kidney sales., and I look.

[02:28] James Stacey Taylor: And I look forward to sharing them.

[02:31] Kim Krawiec: Okay, Liam, you go ahead and get us started. I think we've got Darius up first.

[02:35] Liam Bourque: All right. So to start, a few of our students had questions regarding potential analogues to kidney sales and what sort of comparisons we could make to other markets. The first question we had was from Darius, so I'll pass it off to him.

[02:48] James Stacey Taylor: Sure.

[02:48] Darius Adel: Hi there.

[02:49] James Stacey Taylor: Hi.

[02:50] Darius Adel: So when comparing a firefighter to kidney vendor in your book, you mentioned that the kidney vendor considers the sale to be nothing more than instrumentally valuable and appear to suggest that kidney seller wouldn't perceive their kidney sale as intrinsically worthwhile while an altruistic donor would. So my mom has kidney disease, and I'll probably be donating my kidney to her sometime in the future. I wouldn't accept money for it. But the donation process will be financially burdensome. I can envision a scenario in which one donates because it's intrinsically worthwhile and also because they seek financial compensation. In that sense, wouldn't their motivational structure be similar to many other jobs, like firefighting?

[03:44] James Stacey Taylor: Yes, I think so. And I think that's a really good question because it helps me unpack a little of the structure of the argument. So in comparing kidney sales to other types of employment, what I was trying to do is to make the case for my opponents as strong as possible. So if we're willing to say that kidney vendors are, in the extreme case, are only selling in order to secure a financial benefit, and they don't gain any other benefit, they don't get any warm glow from altruism, they don't care about saving people's lives. They're just somebody who's really miserable and self centered. A sort of Rashab type person, for example, who only cares about money, then it seems that person is going to be considerably different in their motivation from people like maybe a firefighter who does it because it's valuable, or somebody who engages in fishing because their family has always done this. And so they consider the activities to be valuable in a way that goes beyond the mere compensation that they're receiving. So if we take the extreme example of the sort of mean spirited, selfish or sharp type kidney vendor, and we can stay such that the only benefit that they're gaining from doing this is financial, and then if we can argue that that sort of person should be allowed to participate in kidney sales merely for financial compensation, then it seems that we've got a good argument in favor of kidney markets. Does that make sense? Because if I was to argue something like take yourself, Darius, that you donate or somebody like you donates a kidney for the intrinsic value of helping somebody else, whether it's a stranger donation or a family donation, and they want the financial benefit of donating, then it seems that it's going to be a much easier case for me, somebody who favors markets, to say, look, this is somebody who's getting an awful lot of benefit, not just  financial benefit. And we allow people to donate kidneys now as you yourself will do possibly in the future purely to help other people and to get the sort of psychic benefits for themselves and for others. So the more I strip away the altruism from the kidney vendors, the stronger I make my opponent's case. And if I can establish that a purely financially motivated kidney vendor should be allowed to sell, then I bring into the fold everybody else with those people. But I agree. I think my case for kidney markets is actually, in practice, much stronger. Almost everybody, I suspect, is going to have I'm selling the kidney. I might be doing it because I'm in desperate need of money, but this is also a way to help people. So I think there's almost always going to be mixed motives.

[06:51] Kim Krawiec: This reminds me of a conversation that we had on this podcast last year with Stephen Wilkinson, who I'm sure you know, and it just kind of highlights the different ways in which philosophers approach arguments versus lawyers. And Stephen and I talked about this a little bit and you said it exactly the same way he did, which is what we try to do is make the case for our opponents as strong as possible, which is a much better way of doing it. But it's not, as you can see, the way we lawyers do it. Instead, we're like your argument sucks. It's I think that probably explains some of the responses, including mine, to that first part of your chapter. And it's something that came up with Stephen last year as well. I find it interesting that philosophers are just better people, you're just more generous people than lawyers apparently.

[07:40] James Stacey Taylor: You haven’t attended many philosophy conferences, but questions tend to start off with things like leaving aside the obvious absurdity of your conclusions and moving to how your arguments are clearly fallacious and then they go off.

[07:54] Kim Krawiec: I guess I’ve just been lucky with the philosophers that I’ve had on the Show so far,.

[07:57] James Stacey Taylor: But it might be that. And just to touch on the methodological differences, my suspicion is that good lawyers will also have ready the best arguments for their opponents. Not present them in court or in litigation or in negotiation, but to be aware of what they are and have responses ready.

[08:18] Kim Krawiec: Yeah, I think you are right about that. It is a different argumentation style that I think, again highlights some disciplinary differences, which is nice in and of itself.

[08:28] James Stacey Taylor: Oh, absolutely. Thank you, Darius

[08:30] Liam Bourque: Up next we have Dennis.

[08:31] Dennis Ting: Yeah, thank you so much for being here and taking time to talk with us. I wanted to go into the argument that you wrote about the argument being made that kidney selling is not analogous to military service. So in your book you write that soldiering is an activity that people choose to perform because they choose to engage in these activities for their own risks, while selling a kidney is typically done because this is the only way they can think to raise money that they need. And so I can see the argument being made between things like mountaineering and other recreational daredevil activities, but I think there's also that strong economic incentive for people to join the military with the promise of a free education and other benefits. So how do you reconcile this argument? And is there a distinction between the economic incentives of selling a kidney versus joining the military?

[09:27] James Stacey Taylor: Yeah, I think that's a really interesting question and I started to think more about it when I read your written version of this and I think that the answer is going to be twofold. So I think that you're right. There's going to be similar financial incentives for people to join the military. And I can envisage people joining the military purely as a way to sort of escape the area in which they grew up. You grew up somewhere that's economically depressed. There's really no real way out. So you go to your nearest recruiting office and you join the Marines. And I suspect that in those cases there's obviously going to be a lot of financial incentive. You get the college benefits, you get the payment, and there's also going to be a considerable amount of honor attached as well. So in the United States, when I first came here, I found it really odd that people are so sort of grateful to the say, you know, thank you for your service. People in uniform get to board first on planes and so forth. In Britain there's absolutely none of that. You sort of have Kipling's poem where there's in peacetime the military are regarded as an unpleasant nuisance and you know, and in peacetime it's, Tommy, move out of the way. Tommy, get out of my way Tommy, you're annoying, and so forth. But when the war comes and everybody's cheering as they go off to glory, presumably. So the US context, I think is fascinating and interesting for me. And so the first part of response is I think you're right, there's going to be financial motivation and compensatory motivation for people to join the military. But I think the second part of my response is to build on that. So clearly the difference between Britain and the United States with respect to the military shows that these norms are not set in stone. They can be changed. And I would like to see people being encouraged to view people who give themselves in donating kidneys or plasma or blood as being seen as honorable, just like people who join the military are seen as honorable. So you're considered a lot of people say you're a hero if you donate a kidney. I think that should be expanded to people who donate plasma as well. So you are somebody who's giving of yourself and you're making strangers lives much better. Are you doing it for pay? Sure. But so are teachers, so are nurses, so are doctors, so are people who serve in the military. So I would like to see some way of shifting the cultural norms to view people who donate body parts as being just as worthy of praise as people who perform other public orientated jobs.

[12:18] Dennis Ting: Thank you so much. Appreciate it.

[12:19] James Stacey Taylor: Excellent. Thank you.

[12:21] Kim Krawiec: James, do you have some thoughts on why it is that we are so unwilling to see providers of body parts as having the same types of mixed motives that we assume that most people bring to their jobs and many activities in their lives? I mean, I'm just always surprised that people simply the insistence that kidney sellers must be motivated only by financial desperation and that that somehow undermines any altruistic feelings that they might have is interesting to me. I don't know where it comes from.

[13:02] James Stacey Taylor: I don't know either. So that's going to be a very unhelpful response. But here's an analogy that I've been thinking of. So it seems that with respect to kidney sellers, because the expected amount is so large, you receive, let's say $150,000. That's just the number I'm making up. But $150,000 for receiving a kidney, for donating a kidney. To most people, that's a pretty large amount of money. And so people might think, well, you're just doing that for that large amount of money. And here's where the analog comes in. I've seen a similar response to academics who are paid large amounts of money. Now, there's not many of them, but if you're somebody like, say, Michael Sandel or, oh, Francesco Gina at Harvard who's recently been revealed she has a very large salary, and some of the discussion of those people, I think, has the same slant as it does with respect to kidney vendors. It's like, why are you doing this? Why are you engaging this research? Well, it's obvious because Harvard's paying you a million dollars a year. So there's no real understanding. Even among other academics who I think are largely motivated by jealousy against people who have very high salaries, there's no real understanding. It's like, that high salary is a bonus. It's like a really nice bonus, but you're getting to pursue things which you're really interested in. So it might be that once we move beyond a certain amount of money, people say, well, that's such a large amount of money, you must just be doing it for the money. Completely ignoring the fact that for many people it might be, I'm really lucky. I'm getting paid a large amount of money, and I'm getting to do what I love.

[14:52] Kim Krawiec: Yeah, that does sound plausible in the context of academics, possibly kidney sellers, although most of them don't really get paid, I think, such a large amount.

[15:05] James Stacey Taylor: Right.

[15:06] Kim Krawiec: It makes to me no sense in the context of plasma donors right. Where the typical complaint is that they're not paid enough, something that I also am not particularly sympathetic to. But I don't know how to square it with plasma donors where people tend to think that they're being taken advantage of in some way rather than the opposite extreme.

[15:29] James Stacey Taylor: Yeah, and I heard a lot of complaint that plasma donors should be paid more, but I've also heard a lot of complaint, and I think we'll touch on this later, especially from people in Canada or in Europe, plasma donors shouldn't be paid at all. And that seems like it's a really weird set of arguments that people are engaging in. So on the one hand, you're saying plasma donors, we shouldn't have payment for plasma. You say, well, why? Because those poor plasma donors are being exploited. They're only receiving a small amount of payment, and these pharmaceutical companies are making large amounts of money. I don't know if that's actually true, but even if it was, the response wouldn't be to say, well, then we should make sure that the price they're paid for their plasma is zero. Yeah, that's weird. The argument should be you should be paying them more and we should be encouraging more compensation. But the European and Canadian context, they're exploited, and so we should ensure that they're even more exploited, which is weird.

[16:25] Kim Krawiec:Yeah, yeah.

[16:30] Liam Bourque: Thank you for the response to that. So next we have a question from Julia and I'll let her take a lead.

[16:37] Julia D'Rozario: Hi, James, thank you so much for when I was reading your book, I was really interested in Robert Audi's argument about irrevocability and it made me think about the relevance of Tangibility. So I imagine for many people, disproportionate repugnance towards kidney sales as opposed to other dangerous jobs may come from sort of an intuitive sense that selling part of your body is just different from most other dangerous jobs. I think people feel fundamentally different about use of the body as opposed to sale of the body, even when both are ultimately used to earn money. Which is why, for example, commercial surrogacy agencies take such care to highlight the process of pregnancy as like a clinical service rather than the dated perception of baby selling. And so I was wondering if you think it's plausible that removing a part of the body is simply different from other dangers in that it constitutes a sale rather than a service, and whether you think that plays a role in people's repugnance towards organ sales despite general acceptance of other dangerous work.

[17:51] James Stacey Taylor: Yeah, I think that's right. And Stephen Wilkinson might have touched on this when you had him on last year, I think, because he has an excellent article which addresses questions of the skin as a prophylactic. And so if you engage in activities which don't violate the prophylactic of a skin, then that's much more acceptable to many people than it is if you violate the prophylactic of a skin, you remove a kidney or you have blood drawn and so forth. So I think you're right that for a lot of people there is that intuitive difference, but I'm not sure that it really makes much of a moral difference. So we can see that people would have objections to all sorts of procedures, not necessarily medical ones. So historically, there was a lot of objection to people taking out life insurance because it was considered to be gambling on people's lives and this was somehow unseemly. You're betting that people will live or die and we ought not to be betting on people's lives, but now nobody really thinks twice about taking out life insurance. So there's been a cultural shift in that respect. And I think that we should try to have try to engender a cultural shift with respect to violating the prophylactic of the skin. We allow blood draws. And we hold up people who give blood to be heroic or altruistic, and we praise those people. And I don't think that there would be any difference if we praised them and also paid them. So once we realize that there are going to be cases where we violate the prophylactic of a skin, we engage in sales of tangible things rather than services involving our bodies, then we can start moving towards showing that there's no real difference between providing a service and providing a body part or an organ. And maybe one way to think about this is people have a repugnance. Many people have a repugnance towards sex work. And in many types of sex work, there's no violation of a prophylactic of the skin. So it's just certain types of sexual activity. There's no penetration at all, yet people are still repugnant about that. So I don't think that we can draw a neat line that penetrating the skin that's bad, and we ought not to do it because we allow blood draws and hold those to be admirable. And services which don't involve giving away body parts or giving away bodily organs like sex work, because we can see that some services are still held to be icky or unpleasant or unacceptable, whereas other services which do involve penetrating the body, such as blood draws, are going to be perfectly permissible. That's a very convoluted way of saying, but I think that at first sight, that's absolutely right. We allow services which don't involve giving up body parts. We feel icky when body parts start to be sold. But we can give examples where we have services with no giving up of body parts, sex work, we feel icky there. And other cases where we do give up body parts, blood draw, plasma sale and the like, where we often don't feel icky. So once we start realizing that we really don't have this neat intuitive boundary, then I think we can start working towards improving things and getting more body parts becoming available commercially. But that was an excellent question, and it made me think quite a lot about where the boundaries get drawn.

[21:40] Kim Krawiec: You know James, just to follow up on that, I think that this distinction is present in the law as well. And I think for the most part, people recognize it as largely being a legal fiction, at least in some settings. But it may be impermissible to sell your eggs, for example. But it is okay to be compensated for the time and inconvenience of the process of donating your eggs. Right. As Julia brought up, we characterize surrogacy, of course, as being the provision of a service, not the selling of a baby. But of course, baby selling is illegal and being a surrogate is not. And so I think especially in the case of the provision of gametes, people sort of recognize this as being a legal fiction.

[22:23] James Stacey Taylor: Yeah. And this is a little story which really annoys my students. So a few years ago, there were adverts being taken out in the college of New Jersey's newspaper recruiting women for surrogacy services and for provision of eggs. There was also the same company was advertising in Princeton's University newspaper, Princeton's about 5 miles down the road. Now, the prices that were being offered for the time and inconvenience of Princeton women were quite a bit higher than the time and inconvenience of a College of New Jersey women. So either there's something going on here in perceived evaluate of these gametes, or I told my students, maybe the Princeton people are just not they're just really good at providing eggs and so their services are worth more than yours, or maybe there's something going on. They didn't like that comparison at all, but it was pretty clear it's not really time and inconvenience that you're being compensated for given these differentials.

[23:20] Liam Bourque: Our next section is about utilitarianism, paternalism and morality. And our first question up will be from Aamina.

[23:27] Aamina Mariam: Hi, thank you again for coming to talk to us. So it kind of seems that from the excerpts that we read, that the overarching argument was that from a utilitarian perspective, if a certain activity provides a net benefit and an individual is adequately informed of the risks involved, then we should respect their autonomy and allow them to partake in the activity if that's what they choose to do

So where would you draw the line, if at all? Are there any parts of the body or the human experience that's just too sacred to commodify? Or is there a point where the risk would just outweigh the societal benefit?

[24:05] James Stacey Taylor: I think you've characterized my general approach accurately. So I'll just dive in and say, I don't think that there are any parts of a body that I would not be willing to commodify. Now, there's going to be a difference between what we would commodify in theory and what could be commodified in practice. So in theory, I would be perfectly happy for people to be selling their vital organs like a heart while they're still alive. In practice, of course, no hospital is going to go near that. That's just not going to be a viable market. But I suspect, Armina, that you would be in favor of allowing heart sales, too, even though you look like you're a little bit horrified at this think. And here's why I think that. So imagine that I'll just pick somebody. Imagine that Liam is going to die in two years time if he takes a certain type of medication to keep him alive. So he has a terminal disease, and if he takes the medication, he will die in two years time. If he doesn't take the medication, he's going to die in a month. Now, here's the catch. Liam's insurance coverage doesn't pay for the medication. He has to pay for it himself out of pocket. Now, I'm not going to ask what do you think liam should do instead? I'm going to ask. Do you think liam should be allowed to make the choice as to whether he buys the medication or not?

[25:40] Aamina Mariam: I would say so, yeah.

[25:42] James Stacey Taylor: Because if you say yes, and I would agree with you. Notice what you've told me. You've told me that liam should be allowed to make the choice, presumably in consultation with his family and loved ones and so forth. But the choice should be liam's as to whether or not he dies in a month's time, saving money for his family, or if he expends all of his estate, keeping himself alive for another two years. So really, you've told me Liam should be allowed to choose to die early and leave the money to his family members. Now, if that's the choice Liam should have. Now, imagine that Liam doesn't do well in law school. Things look bleak for him, but he wants to leave a lot of money to his family members, and he decides, I'm going to sell my heart. Now, you've already told me, AAmina, that he can make a decision for himself, that he can die earlier than he would have done in order to provide for his family. So I don't see that there's any difference here, morally speaking, I think that liam should be allowed to make that decision. 

[26:45] Aamina Mariam:That makes sense. Thank you.

[26:50] James Stacey TaylorExcellent. So now I've just convinced you that heart sales are perfectly morally permissible.

[26:54] Liam Bourque: Kate, you're up.

[26:54] Kate Granruth: Hi, James.

[Thank you again.

I echo everybody'sthanks for being with us today. I had a question sort of about what happens when the social good is so great that maybe we should just mandate the thing that gets us there. So the book seems to identify the good that comes from compensating donors as an increased supply of plasma and organs. And I was wondering, if that's what we're so worried about, shouldn't we just automatically enroll people in organ donation when they get their driver's license? In your view, is it ethically and morally sound to preserve individual choice when such a massive social good could be created, especially given that kidney sellers are probably already making a choice that is somewhat constrained given life circumstances? And so what exactly is the value of compensation on an individual level if the desired good outcome is for society writ large?

[27:50] James Stacey Taylor: Okay, let me ask you this question just to clarify what you're asking. Are you in favor of having something like an organ lottery? So when you get your driver's license, you have your driver's license number and that's entered into a database. So if Mary Beth ever needs a kidney, we've got your blood type and mary beth's blood type. And if it's Mary Beth and three or four other people who need organs and they all match you, kate, then we can just pull your number from the lottery. We'll send around the department of health and human services and they'll just stripmind you for your organs? Is that the idea you have? We just have an organ lottery.

[28:28] Kate Granruth: My idea is a little separate than that in terms of it's more the earlier step than that of automatically putting that little heart on your driver's license. At least that's.

[28:38] James Stacey Taylor: Oh, I see. Yeah. So we have something like instead of having an opt out system for deceased to donate an opt in system for deceased donation, we have an opt out system. We have moved to presumed consent, right? Yes. So I'm in favor of that. I think that's a good idea. I'm in favor of that for not really for the practical reason, that you might be thinking, because I'm not convinced that it would actually generate a significant additional amount of organs.

[29:12] Kim Krawiec: I'm not either. And I think it might decrease it.

[29:15] James Stacey Taylor: Because in order to have an organ that becomes viable is viable. If somebody's killed in a car accident, for example, with head trauma, we're going to have to have somebody within reach, as it were, who's going to be a potential recipient, and we're going to have to have the medical infrastructure to get that organ over to them quickly. And it's not clear that's always going to be in place. But I am in favor of presumed consent. But that's because I don't think that the dead can be harmed or benefited. I think that once you're dead, that's it. And most people agree. But a lot of people think that we should take the interests of the dead into account. I don't think we should because I can't see how fulfilling or fraughting somebody's interest once they have died is going to be either a harm or a benefit to them. So I'm in favor of presumed consent in part because I think it might get more organs, but it might not, but more because I don't think we should be in the business of respecting choices of people who are now dead.

[30:26] Kim Krawiec: What about people who have religious beliefs about the intactness of the body in the afterlife? The harm might not be to them since they're dead, and assuming I don't believe in the afterlife, but their families might suffer psychic harm from something like that, does that affect your answer at all in a culture that has that religious belief?

[30:48] James Stacey Taylor: Sure. And I think that this also shows that my suspicion that the dead can be harmed and benefited doesn't mean we have to rejig how we treat wills or estates or bequests. Because I can imagine a society where everybody agrees with me that the dead can't be harmed or benefited. But people do have interests that extend beyond the scope of their lives. You want your alma mater to flourish, you want your children to do well, and you want those desires to be satisfied, not for your own sake, but for the sake of your alma mater or your children. So I can see people saying. Sean. I can't be harmed or benefited after I die, but I would like a general social practice whereby people's wishes are generally respected post mortem, so that I can leave my money to my children or to my University of Virginia law school, and I can be confident that those wishes will be fulfilled. And I think people would prefer to be in that society than in one where once you die, then it's sort of a free for all on your estate. So I don't think that it's benefiting the person who is dead to respect their wishes. But I think that given how people's motivations tend to be, it would be a good thing to respect the wishes of a dead, generally speaking, unless we have overwhelming social reason not to do so, which is where Kate's concerns about removing organs might come into play.

[32:20] Kim Krawiec: Thanks.

[32:21] Liam Bourque: Thank you for your answer. On to Gabriel.

[32:23] Gabriel: So you write, respect for kidney stellar's autonomy still requires that they be allowed to sell if they so wish. And I think in reality, we stop people from doing things to themselves all the time. We involuntarily commit people who are danger to themselves and at risk of attempting suicide. In other words, we intrude on personal autonomy in some deeply paternalistic ways. And it's not clear that moral objections to kidney selling are so pedestrian to preclude intrusions on the kidney selling realm too.So the simple question is if Broad.

Majorities agree on kidney selling's moral impermissibility, why ought we not to intrude? To prevent it.

[33:04] James Stacey Taylor: Good. So if I could, I'd like to divide your question into two parts. So the first part, I think addresses. Can we legitimately infringe upon people's autonomy in order to act paternalistically towards them? And the second part concerns, if we generally agree that something is morally impermissible, can we restrict people from engaging in those actions? So with respect to the first line of argument that we do, as a matter of fact, infringe upon persons autonomy all the time, for example, as you outlined, we prevent people from committing suicide. We might involuntarily place people into medical facilities if we think that they're in danger of harming others or themselves, and we'll just focus on themselves. I think that those types of actions could be permissible. But now we're in the business of seeing how far are we willing to go with respect to those paternalistic interventions. So on the one hand, we have the extreme examples somebody is really distraught and they have a weapon and they want to kill themselves, and we restrict them from doing so, we interfere with their decision. We might even place them involuntarily into a medical facility and keep them under observation. So I think it might well be permissible to do that, to infringe people's autonomy when they're going to commit suicide. But the example that we are working with is where somebody's really emotionally distraught and they might not be thinking things through. Clearly now we might have another situation where somebody has they've received a terminal diagnosis, they know that their prognosis is going to be extremely painful, and they're thinking, maybe I would like to have physician assisted suicide. In that case, it's not clear to me that we should be interfering with people's decisions to the extent of precluding them from receiving physician, assisted suicide, or euthanasia. We might act paternalistically in the sense of requiring them to seek more than one medical judgment, secure second opinions, talk through counselors, maybe even talk to people who've been in their situation and have decided not to commit suicide. So you can imagine somebody who's become a paraplegic as a result of an appalling accident and thinks, my life's worth not worth living. And then we say, well, maybe you might reconsider after you've spoken with people in a similar situation. So with respect to kidney sales, I think that as we start to move down a slope from extreme harm to people in emotional distress, where we have more reason to be paternalistic to people have fought this through and they still want to inflict harm upon themselves by killing themselves. If we believe that killing themselves is harmful, and then we move down towards something like kidney selling, which is a relatively low risk activity and might gain a significant benefit for the person who's engaging in it, because, after all, we allow people to donate kidneys free without compensation. And the risk profile for those people is presumably, at least in principle, identical to people who do it for money. So if we're going to start paternalistically interfering with people, then we should do it not just to commercial kidney sellers, but also to altruistic kidney sellers or to kidney donors. So we might have to tell Darius, look, you just can't donate to your kidney. And that seems to be a bridge too far that seems to me to be far too paternalistic. I think Darius should be allowed to make his own decisions given the situation that it will be in. So with respect to paternalism, I'm not in principle opposed to paternalism, but I don't think it's necessarily going to apply at the level of kidney sales. Now with respect to should we start interfering with people if we have a consensus, but it's morally impermissible, I think absolutely not. Because we've got lots and lots of historical examples where there was a consensus that people ought not to do certain things. And we look back in horror at what people were doing to stop individuals behaving in certain ways. So, I mean, obvious example will be smoking marijuana. We've put people away for a long time for basically ingesting the botanical equivalent of a bottle of vodka. That's appalling. We shouldn't be doing that, even if we're doing it because we think it's good for the people who are smoking marijuana. It's like, let people do make people make mistakes, and maybe they're not making mistakes. We're the ones making mistakes. So I think coercively interfering with people's lives is something we should be very wary about doing. And only at very extreme cases should we start involving paternalism. Does that answer your question? 

Gabriel: t does. Thank you

James Stacey Taylor: And I think we should also be very wary about people who are so morally certain of their views that they're willing to impose them on others by force. Those people scare me, frankly.

[38:27] Kim Krawiec: James, how would we describe what distinguishes, say, the suicide case from the other cases? Is it that we think that sort of the future person will be grateful that we intervened on their behalf? Is it that there's a high probability that they're not thinking rationally? And I guess if it's the second one, that seems like more of a slippery slope type of problem, since probably there are plenty of people out there who would assert the same thing about kidney cellar. Actually, there may be opponents that would assert both of those things about kidney cellars, come to think of it. I don't know.

[39:06] James Stacey Taylor: Yeah. So the two things are not thinking rationally and sorry, what was the first one?

[39:14] Kim Krawiec: Well, I mean, maybe it's the same, but it seems to me that when I think of I think you call them red flag laws, right. Where we take a gun away from somebody who is currently a threat to themselves. I think the usual justification, even among people who are otherwise libertarian leaning, would be, well, that person just has a temporary alteration to their psyche and behavior, and a week from now, they'll be really glad we took the gun from them. Right. So it's sort of temporary. Maybe that's the same thing as not thinking rationally. Although, I suppose irrational thoughts. I don't know. It strikes me as both being a little harder to judge but also potentially being longer lasting. I don't know.

[39:59] James Stacey Taylor: Yeah. Yes. I think those are two different cases, two different factors that we'll take into account. So we might say you've just undergone a really bad accident, and here's a real case, which is a really grim case, and it's a case I found out by accident just because of my name. So like most academics, I Google myself periodically, and it turns out that there's one other James Stacey Taylor in the United States. And this explains why, when I was applying for citizenship, I had to sign an affidavit which had to be notarized, and go to the immigration service saying I had never lived in Florida because the other James Stacey Taylor lives in Florida and is not a particularly nice person. He's got all these sort of minor misdemeanors. He's got, like, little domestic assault charges, hunting deer without a license. He's just kind of not a very great person. So I had to say I'm not that guy. But here's where it comes to your question. I discovered about a month ago that his life took a major turn for the worse. And this is a horrible story. He was trying to fix his electric line because the electric company in Florida was refusing to do necessary repairs. And as a result of this, he was not an electrician. He's some guy who hunts deer without a license and so forth. But he suffered there was some sort of explosion, and he suffered massive, massive horrific burns. So he sued the electricity company and he recently won, and he got a very, very large judgment. Now, here's where it gets interesting for us. I can see somebody like that immediately after coming, he's recovered, but I think he actually is a paraplegic. He's been severely disabled. And I can see somebody in that situation thinking, I don't want to live. Now they're thinking rationally. They say, Look, I cannot do anything that I previously enjoyed. I'm all on all of these medications. My life has been severely constrained. No amount of money, no amount of the damages is going to get my life back, and I would like to die. I don't know that this is his situation, but it's just an example, which I think is pertinent. Now, he could be thinking perfectly rationally in making that decision now, but it might be that a year or two down the road, he reverses his decision and he says, I'm grateful that I wasn't allowed to take my own life at that particular point, because as I understand it, people adapt to their circumstances pretty well. People tend to be very versatile. And so he might have what he now considers to be a very fulfilling and pleasant life, even given his very constrained situation. So I think that we can look at two things. Is somebody thinking rationally, or is this a heat of a moment type thing? If it's heat of a moment, then and you've got a gun and you're saying, this is terrible. I'm going to commit suicide, I think that there's a good reason for us to say, we're going to take that weapon away from you. You're not really thinking rationally. But even if you are thinking rationally, you sit down and say, look, I've gone through all of the data. I know what's happening, and I understand that people can be versatile and their expectations can change. And most people in my situation would be grateful. I still want to commit suicide, given my situation. I think in those cases, even though we say, yes, you're being rational, we might say you don't really understand what your situation is until you've experienced it for a certain period of time. So I would be perhaps leaning more towards the paternalistic side, even in those types of cases where somebody's rational, but might not really grasp, because they can't grasp until they've experienced it, what their life is going to be. And then, of course, if it turns out that after, say, six months or a year, however long, we require they say, look, I still want to commit suicide, then I think that they should be allowed to do so. And of course, the famous case of this is DAX Cowart, who had massive burns all over his body. And even after he got married and his life was going very well, he still maintained, you should have let me die at that particular point. And that's the interesting case and the hard case for somebody like me, 

Kim:yeah, thank you.

[44:40] Liam Bourque: All right, so next we have a question from Mary Beth, and I'll let her jump in with it.

[44:45] Kate Granruth: Hi, professor. Thank you so much. So in your article, you kind of talk about how kidney sales and dangerous employment get brought up and they get compared to each other, and you note that you can quit a job at any time, whereas kidney donation is irrevocable. But just because something is irrevocable doesn't mean it's immoral. My question is, well, maybe it's not immoral to sell your own kidney. Would it be immoral to buy someone's kidney? Because I personally just feel like the finality of buying someone's kidney from someone desperate enough to sell a kidney. It does make me uncomfortable with the idea.

[45:29] James Stacey Taylor: I'm willing to say that there could be an asymmetry between the morality of selling and the morality of buying. So you might say, look, if somebody is in desperate straits, then providing they're not harming somebody else, then they can perform services or sell body parts to enhance their own situation. But it might be that we might say, well, some purchases are going to be immoral, even though the seller might be willing to engage in it. So, for example, Dennis is desperate for money, and I know that Dennis is desperate for money. There's nothing immoral about Dennis dressing in a chicken suit and running around UVA's campus making weird noises with I'm Dennis Velooza on a big sign on his back. But there's something unseemly about me saying, well, Dennis, you seem pretty desperate. And he, you know, I'll do anything. And he's thinking I'm going to hire him to maybe do some paralegal work or something. I said, Well, Dennis, I've got this chicken suit, and I'm just kind of an ass, so I'd like you to humiliate yourself for money. Now, we might look at Dennis and say, he can do that. Poor Dennis. And then you might look at me and say, taylor's such an ass for doing that. A virtuous person wouldn't have made that offer. So I can see that there could be an asymmetry in some cases, but when it comes to kidney markets, I'm not sure that the asymmetry is really there. So when I'm going to purchase a kidney, I am almost certainly going to buy it because I need it, because I've got a medical need for a kidney. And so I don't think we would look at somebody who's in desperate need of a kidney because they have end stage renal disease as doing something that's immoral or making a wrongful offer. It's not like me with Dennis where I'm just exerting my superior economic position just to humiliate him because I'm an ass. In this case, it's somebody who's in desperate need of a kidney and the person on the other end, the seller, is in desperate need of the money. So this seems like a mutually beneficial exchange. Now, we might try and push on that and say, well, what if somebody wants to buy a kidney just because they want to feed it to their dog? And they say, you approach Kate and say, kate, I'd like to buy one of your kidneys, kate's in desperate need of money. And Kate says, sure. And then I say, well, there's a catch. You've got to watch me feed it to my dog. As I laugh, it's like, well, then I say, it's not clear that that sort of trade we might legally say, you can do that, but it's not clear that we would really look upon me as being a morally upright person, in part because it's humiliating. Kate like, I tried to humiliate Dennis with a chicken costume, but also it might be because there I'm deliberately destroying something which could otherwise have been used to save somebody's life. It's like somebody who might buy insulin where there's a constricted supply of insulin and then pours it down the drain and does a TikTok video and says, ha, look at you diabetics, you're going to suffer. So that, I think, would be morally wrong, but not because of a trade. It's because you're abusing the item in question. Does that answer your question? Weirdly?

[49:04] Kate Granruth: It definitely answers my question, thank you so much.

[49:07] James Stacey Taylor: But I think that you're right. And the observation that there could be an asymmetry between buyer and seller, I think is one which doesn't appear enough in the philosophical literature. I think that's really insightful.

[49:18] Kim Krawiec: So, James, just to follow up on Mary Beth's question and your answer to it. So it sounds to me, in terms of this asymmetry there's perhaps a spectrum. And at one end, you've know, paying Dennis to dress up in the chicken suit or whatever, it was just to humiliate him. That is immoral from the purchaser's perspective versus the kidney purchase, which is to save yours or someone else's life and that would be moral. Two examples, and I'd like to know where both of them fit on your spectrum then would be dwarf tossing and sex work. Again, looking from the purchaser's perspective, where do those fall in that?

[50:01] James Stacey Taylor: So both dwarf tossing and sex work are really interesting and I think that both could be morally permissible from a point of view of a purchaser. So, as I understand it, the dwarfs who are tossed actually enjoy this, from what I understand. But let's make my possession harder. They really don't like it and you're just doing it as a way to exert dominance over somebody. So in that case, we might say the person who is selling their services as Batosi, the dwarf who is tossed, they're not doing anything morally impermissible, but Batos might be doing something morally impermissible in that they're doing this just to humiliate the other individual. Having said that, I still think that we might say it's morally suspect of you to engage in this activity, paying people to be tossed as dwarves, but we should still allow it because it might be the case that this is the best opportunity that the little persons have for actually making a financial recompense. And I would give the same type of argument with respect to sex work also. So we can make the argument harder for me by saying, imagine that it's somebody who wish is to employ sex workers purely for the pleasure that they receive in humiliating them. So we have somebody who's really unvirtuous. And I think that in those cases, we might say we would consider you an unvirtuous person, but the transaction overall should be allowed to go on. And consider an analog. So people who engage in big game hunting and as I understand it, there are communities which rely on big game hunters to come in and shoot things in order to raise money for themselves. Now, I find it OD that you might want to go and shoot defenseless animals purely for the sake of stapling their heads onto your walls and say, look, I shot a big defenseless animal. So I would consider those people to be non virtuous individuals. They take pleasure from the suffering of animals, let's say. But I would say we ought not to ban that type of big game hunting, because overall, the benefits might be good for everybody involved, except presumably the animal. So we can criticize people for engaging in certain trades while still saying the trades should be permitted. Yeah.

[52:44] Kim Krawiec: Thank you.

[52:45] Liam Bourque: All right, so our next question goes to Darius, and I'll let him lead off.

[52:50] Darius Adel: Hi again, James. I can call you James, right? I feel like we're friends now.

[52:55] James Stacey Taylor: We are.

[52:56] Darius Adel: Great to hear. Exactly. Okay, so, James, at the end of chapter 60, right. Concern for the autonomy and the well being of persons who need to receive a transplant kidney might lead to the conclusion that such organs should not be procured commercially, even if such procurement would respect the autonomy and the well being of the vendors. Could you please elaborate on that statement a little bit? Because to me, it appears that under those circumstances, commercial procurement might be more favorable.

[53:34] James Stacey Taylor: Right. And I think you're right, and I think I'm not quite sure what I was thinking when I wrote that, to be perfectly honest, because the book's 15 or more than 15 years old now. So I think the book what I was after in chapter six, this is the chapter where I talk about a regulated market. Yes. Or am I misremembering.


James Stacey Taylor:So it might be that what I was after was something along these lines and I was expressing myself poorly. That roth I think that commercial procurement is going to be beneficial for people who need a kidney. So I think that you're right there. I think what I was probably after is stating that we might see an asymmetry between procurement and distribution. So it might be and this is where I think I was probably in error in the initial book, that it's good to procure kidneys commercially, but we might have a non commercial system of distribution. So I could imagine you have Medicare and Medicaid serve as kidney procurers. They buy kidneys commercially, but then distribute them on non commercial means to people who meet requirements to receive kidneys. So people who don't have private insurance, for example. So we can have a separation between commercial procurement, where it's simply commerce. We can even have bidding for kidneys and so forth. But some of the players who act as buyers then distribute on questions of medical need. So I think that's probably what I was going for there. But I agree with you. It's weird as it's written, and it might well have been an error on my part.

[55:24] Kim Krawiec: They read one chapter in isolation, and I think that within context, it probably made sense.

[55:28] James Stacey Taylor:, we hope, but it might not have done. Sometimes I've read things and think, what was I thinking? That's so silly.

[55:37] Kim Krawiec: Same but same and more often than you've done that, I'm sure, since I say things that make no sense more.

[55:45] James Stacey Taylor: Often than you do, but I might have a higher percentage of non sense making things.

[55:51] Liam Bourque: All right, so our next section goes into social perceptions and political realities, and our first question for that section is Jenna so on to Jenna.

[55:59] James Stacey Taylor: Hi.

[56:00] Jenna: Thank you for joining us today. I just want to talk a little bit about why people feel the way that they do about issues like kidney donation and plasma. So to focus on plasma specifically, I noticed that a lot of people have a really strong objection towards allowing compensation for plasma donors. A good example of this that you get into in the book is the Canadian Nurses Association advocating against changes to allow payment for plasma donation in Canada? In the context of Canada specifically, do you think there's anything to the fact that they have universal health care, so there may be an existing bias against allowing profit to enter the medical system as opposed to the, you know, we have a very know, pharmaceutical, industrial complex situation going on, and we do allow payment for plasma.

[56:53] James Stacey Taylor: Do you think that this is a.

[56:55] Jenna: Potential explanation for why there's different attitudes, or do you think it's something else?

[56:59] James Stacey Taylor: I think that's a possible explanation, but I think that the explanation might lie elsewhere, and for two reasons one speculative and one non speculative. So the speculative reason is this if the canadian Nurses Association, which is a professional body, were really interested in Canada's universal healthcare being very completely nonprofit. Presumably they would be advocating for nurses to receive lower wages and lower salaries to enhance the nonprofit status of Canadian healthcare. Because it seems odd that you say Canadian physicians get paid, nurses get paid, healthcare providers get paid, people who make pharmaceuticals get paid, and yet some people can't be paid, like plasma donors. That seems weird. If you really wanted to embrace a completely non profit approach, why not go the whole hog and have the Canadian Nurses Association holding bake sales to have their salaries paid? But they don't do that. And my suspicion is Canadian Nurses Association probably lobbies to have Canadian nurses salaries raised periodically. I suspect that goes on. So they're not really as wholeheartedly nonprofit as they might appear. But that's the speculative approach. The more practical approach is, I don't know if this is true of the Canadian Nurses Association, but I do know that it's true of other associations such as the Ontario Public Sector Workers Union or Ontario Public Sector Employees Union. They are also very much opposed to what they perceive to be commercial plasma procurement agencies coming into Canada, and they lobby long and hard to try to keep them out of Ontario. And I discovered that this struck me as being really weird, because a lot of their public pronouncements run like this, like the Canadian nurses. They say, look, we have the creaver report in Canada which details all of the poor quality of blood and plasma during the AIDS crisis in the 1970s and 1980s, and a lot of that was driven by the commercial sector. We don't want that to be repeated, so we should keep out the commercial sector. Now, on the face of it, that seems like a reasonable, good faith argument until you realize that Canada imports an awful lot of its plasma and plasma derived medical products from the United States, and they know full well that those are coming from the commercial sector. So this is weird, right? If you say that, look, commercial plasma is really dangerous, then you would presumably, and if you believe that you would presumably block imports from the United States, but you don't. So it seems something else is going on here. And so I started poking around, and the wonderful thing with the Internet is a lot of public documents appear here, including minutes of public sector workers unions like the Ontario Public Sector Workers Union. And in their meetings, they were pretty clear about why they didn't want commercial plasma centers coming into Ontario. They were worried that it would put pressure on public sector worker jobs. So they saw it as straightforwardly competition, and they wanted to keep the competition out. Now, you can't, as a union, really go up to have a publicity campaign saying, we want union wages to be kept high, so keep these people out who are going to secure plasma for our fellow Canadians. That really doesn't seem very appealing. So what you would do is precisely what they do do, which is saying, look, there's the krever Report from 1970s 1980s commercial plasma in Canada. Commercial blood in Canada works really badly. We don't want to repeat of that. So I think that the real answer for at least some people is trying to stifle competition. And there's also something really weird about appealing to the krever Report because that focused on the 1970s and 1980s. That's a long time ago now, and we are in a completely different medical environment. We can test for a lot more pathogens, and we're in a totally different regulatory environment both in Canada and the United States. So this could be relying on the krever Report to say commercial plasma is bad, which it's not. Empirically is rather like me going to a Ford dealership. And they say, well, would you like to buy a Ford, James? And I say, no, I'm never buying a Ford. I only like safe cars. And they say, Well, Fords are really safe. The Ford Fusion safest car in its class. And then I say, yeah, so say you big car manufacturer. But I know that in the 1970s the Ford Pinto used to blow up when it was rear ended. So I'm never buying a Ford again. They'd look at me like I was nuts. They'd say, but this isn't a Pinto, it's a Focus or a Fusion. And if I keep pointing to the 1970s state of descendants, they'll say either something has gone really wrong with your reasoning process, or you just have some bias against Fords for some unexplained reason. So I think keeping to pointing at the Krever Report, which the Canadian Nurses Association do BloodWatch, which is an activist organization against commercial plasma in Canada, and the Ontario Public Sector Workers Union, I think that's rather acting in bad faith. You're pointing to something which is utterly out of date and you know is out of date and you're really just scaremongering. So that's a long way of saying I'm a little bit suspicious of the Canadian Nurses Association. I have no evidence that they're doing this, but I'm not sure that they're as committed to the nonprofit, non commercial approach as they might like us to think.

[01:03:11] Kim Krawiec: James that explains, I think, the position of nurses as well as some other people in the Canadian space. What about individuals who are part of a political system, who are continuing to have the laws that they have which prohibit plasma donation in their own country, but import it from the United States, which is pervasive around the world? Is there an explanation other than voter ignorance, which I think explains a lot of things? Is there anything to Jenna's question that maybe they're just not thinking through? I'm talking about the population now. Oh, no, we're opposed to money and health care. That's not our model. And we know that the Americans, they pay everybody for everything because they're evil capitalists.

[01:04:01] James Stacey Taylor: It might be. But presumably, if that were the case, and if Canadians were more inclined to have an altruistic approach to health care, we would presumably see more donation by Canadians to non compensating centers. But we typically don't see that. We do see Canadians donate, as do Europeans, even though they're not compensated. But there's always a significant shortfall. So if they were really in tune with the general population, we give of ourselves the sort of Richard Titmus approach to things where we encourage social cohesion and social solidarity by encouraging donation, then we would see more donation being done than we actually do. But we don't. And I'm also not convinced that people in general, whether in Canada or in Europe, are as opposed to compensation as we might think. So a lot of European countries and in the United States, the Grass and the Canadian Red Cross do compensate people, but they just don't do it financially. So you can enter lotteries to win significant gift cards or cars. Italy will give you paid time off work if you donate blood and plasma. These are all compensation. So American Red Cross has offered, I think, at the College of New Jersey recently, or at least recently, pre pandemic $25 gift cards for donating blood. Now, they're not paying. They say they're just doing this as a recognition. But it seems awfully like when you offer somebody a $25 gift card, you're offering from a really ineffective form of cash. And if you offer somebody a paid day off work, as Italy does, that's a pretty significant benefit. It's not cash, but it's still compensation.

[01:06:01] Kim Krawiec: That's funny. Some of the earliest guests that I had on the podcast were Nico Lacetra and Mario Maches.

[01:06:09] James Stacey Taylor: They've done fantastic work on 

[01:06:11] Kim Krawiec: who have done fantastic work on this. And some of the students have read their work in my other class. But Nico and Mario, who you may know, have known each other since childhood, I think at least since high school. And one of the reasons that they became interested in this question was because they would see everybody go to the Plasma Center on Friday with the ski rack on, their car already packed because they were getting an extended weekend by donating blood. And so that notion sort of instilled in them, the notion that, well, we are compensating people, aren't we? They're getting a long weekend, and that that is what generated a lifetime of research.

[01:06:57] James Stacey Taylor: Yeah, their work on this is just fantastic. It's so well done.

[01:07:00] Liam Bourque: All right, thank you. I would like to mention one brief thing. When you were talking about the lobbying on the issue, I feel like it's one of those issues that people don't really vote on per se, especially in a parliamentary system. They just vote for the party closest to them in Canada. And I'm not sure it really reflects a values difference at the base level when there's a special interest group, and the vast majority of people are apathetic to an issue.

[01:07:25] James Stacey Taylor: And what's interesting from a practical political standpoint is there's clearly more than one interest group involved, because the commercial plasma organizations are also interested in lobbying too. So I think that there was in Ontario, they prohibited commercial plasma, and then there was lobbying by the commercial plasma organizations who said, look, most of these empirical claims are just not true. And then I think that the ban was lifted and presumably there's now lobbying to get it reinstated. But I think you're right. It's not an issue that people vote on. It's an issue which is one of those things decided by lobbyists behind closed doors.

[01:08:05] Liam Bourque: All right, and so thank you. And so our next question will be from Joseph. So you're up.

[01:08:11] Joseph: Sure. Thanks. So we've seen through our other guest speakers this semester how the commodification of bodily products is largely influenced by societal perceptions. So I'm curious to see if you have any thoughts on kidney sales moral permissibility when framed in the context of societal and cultural norms of, say, non Western countries. So you brought up in the book that certain places like the Philippines, kidney sales are generally accepted, whereas in places like Turkey, someone will face ostracization for engaging in that practice. So in your opinion, what set of morals is the correct one to apply in situations where the act itself may run afoul of local societal and cultural norms?

[01:08:57] James Stacey Taylor: That's a really good question, and I think that there is objective morality. Morality is universal. So I think that kidney sales should be morally permissible, at least prima facial kidney sales should be morally permissible. Now, things become a little bit more complicated if you're in a culture which will utterly condemn people who engage in kidney buying or kidney selling, because now it's not just Jenna sells her kidney and saves Julia. It's Jenna and Julia are now going to be ostracized, and that's a significant cost both to them and to their families. So it might be that the ideal is kidney markets are allowed, but the ideal might not be reachable unless we start to change certain social norms in areas where kidney markets are prohibited as a result of cultural for cultural reasons or religious reasons. And one way in which this might be addressed is if it turns out that most people believe that kidney sale or the sale of other body parts is prohibited by for religious reasons. But it turns out that the religion isn't as clear cut as they might think, then I think that it might be a good thing for some religious leaders to start noting this might actually be something that is going to be advantageous to help your fellow man. And we approve of this within our religion. So perhaps more education would be beneficial. Of course, there's going to be the limiting case where you might have religion which actually condemns all types of giving of the body. So in that case, I'm not sure what to do. So that's going to be a non answer. It might be that there's just going to be some societies where kidney markets, I think, are morally permissible, and I think that the prescriptions against them are ill founded. But there might be no way in which we can actually move from prescription to permissibility because of religious or cultural mores which are so entrenched.

[01:11:16] Kim Krawiec: James, if I'm hearing you, though, the only force of the societal views this goes also back to Gabriel's earlier question is on the practicality of implementation. It does not affect the moral permissibility, which is a standalone inquiry.

[01:11:35] James Stacey Taylor: Absolutely, yes.

[01:11:36] Kim Krawiec: Okay.

[01:11:37] James Stacey Taylor: Now with a wrinkle, because in the case of Jenna and Julia, it might be that the costs that they and their families would incur as a result of engaging in this transaction, they get to count morally, too. So it might be that given the costs, which are a contingent feature of the social milieu in which this trade might take place, it might be that that particular trade would be morally impermissible, but only because of the contingent features of that society.

[01:12:11] Kim Krawiec: But would you then support a paternalistic ban on the activity, or would you still say they are still the best people to judge to weigh those costs and benefits?

[01:12:21] James Stacey Taylor: Yeah, I think they would still be the best people to judge to weigh those costs and benefits. And that's allowing at the extreme case that they make a mistake. And things really do go disastrously badly for both sets of people as a result of the sale, not because the kidney doesn't take, but because there's so much social ostrisism and so much pushback. But I would still not prohibit it. I would allow people to make those mistakes. 

[01:12:47] Kim Krawiec: Got it.Thanks.

[01:12:48] Liam Bourque: All right, thank you. So now we're going to jump to my question. So when it comes to setting up a market structure, if you are going to allow the organs to cross international boundaries, this comes with a lot of reservations, particularly, and you'll see this in other repugnant transactions as well. For example, a lot of people are okay with surrogacy, but see, when people are hiring a woman in a developing country, that there becomes a certain level of inequality where the power dynamics are shifted compared to, say, within the same society, say someone buying a surrogate in Southeast Asia, sub Saharan Africa, India, et cetera. When it comes to organ sales, I think a lot of people would have similar reservations. If there was to be an organ market, would you prefer that it be bounded within an individual country or a truly internationalized market?

[01:13:37] James Stacey Taylor: I would be in favor of a fully international market, and the reason for that is straightforward. If you allow people from developing countries to take advantage of the comparative wealth of the west that's going to work to their advantage. So we will see a flow of well, Nancy Schaefer Hughes is an anthropologist who opposes organ sales, and she says, look, if we have an international market, we will see a flow of organs from brown and black bodies into white bodies. She has a very clear cut view of what's going to happen. And my response is, let's grant that that is true. Purely for the sake of argument, I don't think it will be true. Let's grant that it is. You'll also see a flow of wealth from the developed countries into the developing countries, and that's going to be beneficial for the developing countries. So, sure, you're going to see organs moving in one direction, but you'll see finances moving in the other. Just as we wouldn't want to say we should close down all factory work in, say, Southeast Asia or in China because the living conditions are lower and the pay is lower. We shouldn't close down those factories simply because we think we're somehow exploiting workers in Southeast Asia and we're having to make stuff cheaply. And then it's flowing towards the west. It would be bad for Southeast Asia if we shut down those factories. And the same thing, I think, can be said with respect to kidneys. Liam, you look a little bit unconvinced, which is good.

[01:15:17] Liam Bourque: So I actually do think that on some level, for example, with the Surrogacy example, it does make me a lot more uncomfortable for people to be using people in Third World countries.

[01:15:27] James Stacey Taylor: That's also going to be a concern whether or not people can really consent in that type of situation. But none of that, I think, shows that we ought not to have an international market. It shows we should be very, very careful about how the international market gets structured. So we might say we're not going to take organs from people below a certain economic level in Southeast Asia or sub Saharan Africa. Instead, we're going to take it from people who are at a more educated level but still, compared to developed countries, very badly off. So we might be willing to start screening out people who are very poor on the grounds that we really don't want to be exploiting people and also out of concern that they won't be able to have the post operative care or be able to give full consent.

[01:16:21] Liam Bourque: All right, thank you. Let's move on to Anukriti.

[01:16:24] Anukriti: Hi. Thank you so much for being here. I did have a related question on market structure, and I wanted to come back to your first chapter of the book where you challenge the historical concerns about lower quality blood products resulting from compensating donors, particularly in the context of plasma. And you also detail a lot of research on the safety to donors. But presently, most private plasma donation centers in the United States allow people to donate up to two times a week, but the red cross will only allow them to do so once every 28 days at most. And the discrepancy in the guidelines of the average plasma donation center versus at the red Cross is concerning to me in the context of the health implications that likely informed the red Cross's decision to put out such a significantly different policy. But individuals regularly go to private plasma donation centers and donate at high frequencies, which in part, I assume, is related to the financial compensation offered. I wanted to know more about what you thought about this potential concern regarding donor safety and or exploitation. What ethical principles, if any, do you think should guide the design and implementation of compensation systems for plasma or blood donation to ensure both the safety of the products and the donors well being?

[01:17:51] James Stacey Taylor: Excellent. Yeah. So this is actually part of a book which the part concerning donor safety is something that I did an awful lot of research on and came up with very little because there's not all that much information on donor safety out there. But it does seem to be a concern that blood donors are able to donate much less than commercial plasma centers. But I think the reason for that is largely driven by exactly what you are donating. So when you donate whole blood, you're donating the red blood cells come out, the white blood cells come out, the plasma comes out, and the platelets come out. So you're donating whole blood, quite literally all of it. But when you donate plasma, it's only the plasma which is taken. The red blood cells for platelets and the white blood cells are all returned into your body. So it's a much less intrusive procedure with respect to what you're giving up. And I think that what's interesting for me is commercial plasma centers won't take donors who've donated whole blood. I think it's eight weeks prior to their plasma donation. So donating plasma is less intrusive medically than donating whole blood. And plasma centers, I think, recognize this in restricting who can donate plasma to people who haven't donated whole blood two months prior, because the donation of whole blood is, it seems sort of much harder on your body than the donation of plasma. So I think that there's a reasonable medical reason for the discrepancy between how often you can donate whole blood because you're just donating more, and how often you can donate plasma. Now, having said that, I did try to find information about donor health, and what I found interesting was I couldn't find anything that said that the United States, which has a rather permissive approach to how often you can donate plasma, has any worse outcomes than anywhere else. I could find no evidence of that at all. Now, that, of course, doesn't establish that it doesn't have worse outcomes, but it struck me as interesting that there's no medical concern about that, I would think, and this is speculation on my part. I would think that people in Canada and Europe would be very happy running studies to show that the increased frequency of American donation has adverse effects on donor health. But I could find no such studies, and I could find no such evidence that might just because it's not out there, but I just couldn't find it.

[01:20:41] Kim Krawiec: So, James, I think that what Anu is referring to. We talked about this a little bit after her question. Is the Red Cross caps on donating plasma and not whole blood are lower than the commercial centers? I at first assumed it was because they were only collecting whole blood and might be separating it or something, but that's not the case. As you probably know, the Red Cross collects very little plasma because they don't pay anybody. And so I think the answer to this, which is similar to the statistics that you gave in your book, most people just aren't hitting the caps even in the United States, right? Even paid donors, but literally nobody's hitting, I think the Red Cross caps because they're not paying anybody. And so I'm just looking at a news question every 28 days, but the average, or maybe it was even the highest, I don't remember the exact statistic is like four times a year. There's no reason for them to increase right. Their amount, and they can take the moral high road as compared to the paid plasma centers. I suspect that the answer here is just that they don't collect much plasma. That's not their thing. Their main goal is to protect their reputation with respect to whole blood, and that's what they're doing. And there's no need to increase the caps anyway, because nobody hits them.

[01:22:02] James Stacey Taylor: Yeah, that's a very helpful clarification. Thank you. And I think that probably is actually the reason, but the Red Cross really isn't in the plasma collection business. So it doesn't matter how frequently they allow people to donate, but they do have a non medical reason for having a longer period between donations. But they do have a political reason for extending the amount of time between plasma collection, because then they can say, look, we're clearly different from the commercial sector. I'm not sure who they would be saying that to, but they could be saying that, at least in the US. In Canada, clearly they could be saying, we're very different to the commercial sector, and because we're the Canadian Red Cross, shouldn't you be trusting us? Look, 28 days, beats commercial people, who knows?

[01:22:51] Liam Bourque: All right, so our final question is with Dennis and on to him.

[01:22:55] Dennis Ting: Great, thank you. So the last question I have is whether or not you think there's a way for a kidney market to exist alongside the current donation system. So I was kind of thinking about this with blood donation, where technically you are allowed to sell your blood, but the FDA has a lot of rules about it and enough people donate to where it's not really a thing. But is there some sort of way that we could have something similar or see something similar within the kidney context? Is it possible?

[01:23:29] James Stacey Taylor: Oh, yes. So I think absolutely. We're going to have if you legalize kidney markets, there would still be people who donate and don't ask for compensation. Darius is an example of this. Darius has stated even if he could receive payment, he wouldn't want to do so. So I think that there's going to be the opportunity for both noncompensated and compensated markets and kidneys to run in parallel. And the only real difference between them will be that money is changing hands in one and not changing hands in the other. So we wouldn't want the commercial sector to have any lower standards from the current sector. We would want all of the informed consent procedures to be the same, if not more rigorous, because we're concerned that people are going to be pressured by financial concerns. We might even want the commercial sector to require financial information from prospective donors to make sure that they're not being pressured in any way by debt collectors or something like that. So I can see that we would have a commercial system and a non commercial system running in tandem, and I think that they would be complementary. So I can imagine people who would be unwilling to donate to a close relative now, but think that they have to because there's no other option for Uncle Ben to receive his kidney. So if there was a commercial system, then somebody like that could say, look, I don't have to donate. You can have the insurance company acquire a kidney from somebody and I'm off the hook. So sometimes people say, look, if you allow commercial donation, commercial sales, you're going to have a decrease in altruistic donation of kidneys. I think that's probably right, but I see that as very much a feature, not a bug. You're going to be relieving. People who feel pressured to donate from that pressure and their relatives can now acquire kidneys from somewhere else. I think that will be a good thing. And of course, we see this sort of pairing where you have a commercial sector and a non commercial sector functioning already in many, many areas. So think of sex work there. We have a commercial sector for sex, and we clearly have a non commercial sector for sex, but they run in tandem. That's a slightly creepy example. I realized that after I offered it. But we do have commercial and non commercial sex and nobody thinks anything of that. Well, some people think a lot about it all the time, but that's entirely different issue.

[01:26:11] Dennis Ting: Thank you for that. Appreciate it.

[01:26:13] James Stacey Taylor: That was terrific.

[01:26:14] Kim Krawiec: Yeah, thank you. This was a lot of fun.

[01:26:16] James Stacey Taylor: Yeah, this was excellent. Thank you so much. And thank everybody for your questions. Those are wonderful.