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>I donated my kidney, but I’m probably not going to donate a lobe of my liver .... I’m ethical enough to do something moderately hard and painful, but not to do something very hard and painful.

Oh, i actually read your article and decided to do exactly that 😰, that's kinda worrying to hear!

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A friend of mine donated a lobe of his liver; he’s fine. Turns out the liver has some ability to regenerate, and within a year or so you’re back to (nearly?) 100% function. The experience doesn’t seem to have been too hard for him. This is just an anecdote, though, not actual data. If you’re considering donating, do your own research! (I can’t believe I just said that. Please do actual research, not just read some ACX comments and watch a video on YouTube.)

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The HIPAA thing has an easy workaround: you just advertise broadly that anyone who needs a kidney should write to you. That also simultaneously solves the problem of the potential kidney donors (aka the victims of emotional extortion campaign) considering any letter they may receive absurd prima facie.

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And the (relatively) easy way to get around not being believed would be to have someone visit the potential donor at their house rather than just sending a letter. I'm not completely sure about this, but since it's associated with the driver's license, organ donor status might be a matter of public record, in which case some gig-economy smartphone app could be used to track who's already been pestered and refused, while allocating some sort of reward to successful proselytizers.

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I imagine the reason transplant psychologists are so pointlessly paranoid when it comes to anxiety about transplants is that anyone who comes out of a kidney donation thinking "oh man I shouldn't have done that" or "I didn't give informed consent for this" is a nuclear grade PR nightmare for them so they lean all the way into CYA and then some.

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I don't think it's just that. I think it comes from the kind of broader skepticism in the comments that would see it as some kind of grave moral harm if someone donated but wasn't fully informed or made the decision in a imperfect way.

I've talked to doctors who do this kind of stuff and they aren't just making a cold utilitarian/cya calculation. They genuinely feel moral concern about people donating who might regret the choice.

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I saw a lot of this narrative when bioethicists were explaining why it would be wrong to let people take the risk of vaccine challenge trials.

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Nothing against bioethicists individually but asking them to opine about medical ethics is like asking a priest to opine about the existence of god and taking that as sound expert opinion. I'm sure they honestly hold that belief but if they didn't they wouldn't have the job they do.

In bioethics the incentivizes basically guarantee only people who are inclined to defend weird moral intuitions go into the field (and only publish about those places they have said intuitions).

I mean, there is pretty much only one way to be a utilitarian so bioethics can support maybe one (if that) utilitarian with regular publications without being repetitive. But there are a million different ways to defend/explore complex rules and unprincipled intuitions. Worse, I think bioethicists are particularly loath to opine that something people naturally assume is an important moral consideration isn't (feels dismissive, combative and they might feel guilty in ways they wouldn't inside the Overton window).

And if one is being particularly cynical one might even suppose that they have a strong incentive to come up with ways that medical ethics are really deep in ways that require a bioethicist.

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This exactly - the regret seems terrible to me. I'm very worried about the regret.

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But can you possibly believe the regret of a donor who decides they made a mistake would be more intense than the sadness of a person (and their family) who doesn't get a transplant?

Does it make a difference in the imaginary scenario where there is exactly one potential donor and one potential recipent (so no chance they'll get a different donor organ)?

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It's not that it would be more intense - that's not the point.

The status quo is that people with kidney disease will likely die anyway. No one has any obligation to try to change that. We do have an obligation to put our own health first and to not harm ourselves, with rare exceptions for those we are close to.

So it's not about what emotion is more intense. It's about the horror of someone cutting out part of their body and then regretting it. That speaks to me in a really deep and disturbing way.

Check out "The Giving Tree" by Shel Silverstein for a good illustration.

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Status quo bias to the point of "no one has any obligation to try to change that" is, in itself, horrifying to me.

Suppose you've got a magical button with two possible settings, cake or death. First option, a random stranger chooses to eat cake, suffer injury, and may eventually experience regret. Second option, they try to choose survival but die anyway, with certainty. You're saying that latter possibility is better?

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Nov 11, 2023·edited Nov 11, 2023

Morality vs. Axiology. It's morally sufficient to only take care of your responsibilities. It's ideal to do more than that, be altruistic, help strangers, etc.

I'm not morally obligated to press either button.

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I'm very confused by Kronopath's objection. He seems to be bothered by the fact that someone saying, "you should do X it's the moral/altruistic thing to do" doesn't have your best interests at heart. But that's a really odd objection to a claim that **on it's face** admits to not having your best interests at heart.

If I suggest to you that you ought to donate more of your money to bed nets because it's the right thing to do it would be extremely strange to reply, "hey wait a minute, donating money would make me poorer. You're trying to trick me into doing something not in my best interest." I mean, if I thought it was in your best interest I'd say it's in your interest not appeal to a moral duty.

Maybe Kronopath has in mind some kind of best interest that incorporates meeting your moral obligations. But that's still an odd thing because we (if we believe in obligations at all not just a partial order on choices) think it's better if people go beyond their moral duty so it's weird to see any attempt to persuade someone to do that, no matter how overtly it conveys that, as somehow suspect.

The best interpretation I can give to this is to think about what it felt like as a young man who was still catholic when my moral sense was constantly plauging me with guilt and I felt somehow manipulated by it and constant feelings of anxiety that I wasn't being moral enough. I can understand that, but I'm not sure someone who had that kind of anxiety about being moral enough would raise the issue (if you're so guilty you feel coercive pressure to donate how would that same pressure allow you to so clearly critisize even suggesting donating is good).

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Couple of points of clarification.

1. When I said "Most people trying to get you to do something this drastic and unusual don't have your best interests at heart," I didn't necessarily mean something altruistic. I meant literally anything that's drastic and unusual in any way.

2. "Best interests" might be a bit of sloppy wording on my part. You're right that donating a kidney isn't likely to leave you "better off" from a health or personal benefit perspective.

What I was picturing is not so much someone saying "This will benefit you personally" but moreso someone saying "The negative effects of this are mostly negligible to you personally, and you're helping someone. You lose very little and they gain a lot." And then it turns out that the negative effects are NOT negligible, because the person you're talking to undersold the risks. I would count that as "not in your best interest".

3. You may be right that I subconsciously think that someone trying to get you to be a good person has your "best interests at heart". I also grew up Catholic, so maybe there's a kernel of truth to your last paragraph. But I wouldn't say it's strictly driven by anxiety.

Generally speaking, I think that good people often live better and more meaningful lives in the long run. Maybe it's fun for a while to lie and cheat and steal, but eventually your reputation will catch up to you, your web of lies will unravel, and you'll find yourself bereft of people around you to fall back on for support and validation. If you burn people too often, all you'll be left with is the ashes.

That may be more of an emotional belief than a physical one—I'm not even sure if it's possible to "prove" it's true—but I think it's a good one nonetheless.

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Behold! Our assessment of the people who are balking at donating a kidney, and attempting to argue people *out* of donating a kidney are doing so because:

1) They feel scared of the idea of donating a kidney

2) They feel ashamed that they are scared

3) They have a fair amount of pride, and have a strong aversion to the feeling of 'shame'

4) They are intelligent

5) They use their brainpower to come up with a reason for why it is logically unwise to donate a kidney

6) Now that they have a logical reason for their aversion, they can use that to rationalize away the shame

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Ok, isn't that essentially the correct story about most unjustified beliefs held strongly by intelligent people? I mean sure, sometimes it's just an honest mistake but usually when someone has a very confident very unjustified belief (and probably most true ones as well) it's because they have some emotional reason to hold the other one and they justify it?

As long as you believe that people are far better at using intelligence to justify than to determine truth this should be your default belief conditional on you being very confident their view is unjustified. I mean you need some theory to explain the disagreement and you can't believe you are being irrational.

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The beliefs themselves are already based on emotion, so it follows that all the justifications for that belief are based on emotion as well. But ultimately, none of it is actually grounded in any objective reality, so it's inevitable that inconsistencies keep piling up until you end up with a moral compass that makes zero logical sense.

Emotivism is very relevant to this whole situation:

https://en.wikipedia.org/wiki/Emotivism

When people say "suggesting that people donate their kidney is morally wrong," what they actually mean is "suggesting that people donate their kidney is making me feel bad, please don't do that."

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>ell. But ultimately, none of it is actually grounded in any objective reality, so it's inevitable that inconsistencies keep piling up u

If morality is underdetermined by physical facts, there is no reason a contradiction should occur.

> When people say "suggesting that people donate their kidney is morally wrong," what they actually mean is "suggesting that people donate their kidney is making me feel bad, please don't do that."

If emotivism is true.

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It really is hilarious how much vitriol Scott got for doing something completely selfless and simply suggesting that people who want to help others consider doing the same. So many people tie their entire self-worth to how "good" of a person they think they are, so anything that shatters the illusion that they're a saint (such as other people being "better" than them) causes them to lash out. Of course, the only person forcing them to tie up their self-worth to subjective morality like this is themselves. This whole situation seems so utterly ridiculous until you understand it's just the natural consequences of human psychology.

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It all reminds me of something I read back in the days when BLM was the biggest thing around, and it was practically a competition to fall to your knees and show off how much of an ally you were (looking). Well, one woman actually *believed* what everyone was saying about doing good rather than looking good (albeit all the way back in 2015), and donated a kidney in inspiration.

Yeah, it didn't end well for her. The full story is at https://web.archive.org/web/20230307125843/https://www.nytimes.com/2021/10/05/magazine/dorland-v-larson.html (or https://www.arcdigital.media/p/my-kidney-for-your-approval, but that's paywalled), but in short, turns out the worst possible thing you can do to someone is to take them seriously, listen to what they have to say, and live up to the values they espouse. They'll fucking *hate* you for that. For most, it is quite literally unforgivable.

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Public performative morality is always suspect. Plenty of people live their lives doing moral things, and are often embarrassed by attention. The kind lady who looks after her neighbours and shuns the limelight, for instance.

Public morality is something different, it’s somebody on an actual or virtual stage condemning some other people for their immorality. In a different age that might be a preacher, himself gay, condemning homosexuality fiercely. Aware that he is gay, brought up to believe it’s immoral, this seems like an attempt to hide the private vice with performative public virtue.

Can we see it in the modern moralities? Sure. People living in white neighbourhoods who rush out to put up their signs about black lives mattering. However the revealed preferences for people who live in white neighbourhoods is that they prefer their own kind. This isn’t true of poor areas, but it is true of richer areas where you can sell up, release capital and buy somewhere cheaper, somewhere perhaps more multi cultural.

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I saw this comment, I think in the original Kidney Donation post. I don't remember seeing the BLM being the inspiration for the donation; at any rate it went to a white person I believe.

It's an interesting story, and I am firmly on the side.of the donor there. Apparently also this dispute was profiled in the Blocked and Reported podcast. There is some dissatisfaction with how the original reporter covered the issue.

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How on Earth are you on the side of the donor in that story? She was very clearly mentally ill and should never have been allowed to donate.

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Not from a donation perspective, from the perspective of her dispute with the other writer?

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Yeah, how are you on her side? She seemed like a horrible person and the other writer didn't do anything wrong.

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I'm very confused by this comment.

I read the article. D kept bragging about her kidney trying to impress a more successful writer, L, who she liked more than L liked her. L detected some narcissism in the bragging, didn't respond to D, but wrote a story highlighting the narcissism and savior complex inherent in the donation, combined with some race issues.

Your comment seems inaccurate. D seems preoccupied with looking good, and this isn't an example of taking someone seriously and living up to their values at all. I don't understand why you say that.

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I disagree with the original comment in that race didn't seem to factor in the original donation at all.

L made it into a race issue in her story, and plagiarized the text of the donor letter, and lied about it.

To me, to answer your other comment: yeah I would probably find D as not that pleasant, maybe cringy or too intense or needy. But it wouldn't occur to me to mock her behind her back or write a thinly veiled negative story about her painting her harshly to the world. One might react with pity, or distance oneself from a D type character if they find her off-putting, but L took the mean girl option.

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It's simply false that she "plagiarized" or lied about it.

L wrote a fictional story about a fictional character, and it was a race issue in that fictional story.

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'Among her friends, Larson clearly explained the influence of Dorland’s letter. In January 2016, she texted two friends: “I think I’m DONE with the kidney story but I feel nervous about sending it out b/c it literally has sentences that I verbatim grabbed from Dawn’s letter on FB. I’ve tried to change it but I can’t seem to — that letter was just too damn good. I’m not sure what to do … feeling morally compromised/like a good artist but a shitty person.”'

Perhaps "plagiarized" is too strong a word. Perhaps it's not strong enough. Ironically I had stopped reading the article after this paragraph, since everyone involved seemed despicable.

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Scott wasn't "completely selfless." He did it because he believed the emotional rewards of pride, satisfaction, bragging rights, etc were going to be greater than his suffering.

Even he admits he's not willing to donate a lobe of his liver because "I’m ethical enough to do something moderately hard and painful, but not to do something very hard and painful."

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Many people would argue that "Feeling positive emotions at the expectation of others welfare" just *is* what it is to be selfless. Obviously anything that motivates us to act must somehow affect us internally, but it's far less obvious why we should call anything motivated by an internal desire/emotion to be "selfish".

What would be required to qualify as a "selfless act" under this paradigm? Someone donating their kidney even though they have absolutely no desire to do so and feel no positive feelings about it? Why would anyone do that? It feels more like a cheap verbal trick to say "you *wanted* to help people, so actually you're being selfish by just doing what you want".

There's a decent philosophical video on psychological egoism here that goes into more detail than I'm prepared to: https://www.youtube.com/watch?v=aZo17VyemSc

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Go read Scott's essay in response to the comments on the kidney donation. He says he's ethical enough to do something moderately painful and hard (kidney donation), but not ethical enough to do something really painful and hard (liver donation).

Not even Scott thinks he's selfless, but I'm sure he enjoys other people thinking he is.

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I think you're thinking of altruism. Feeling good at helping people is altruistic.

He didn't say it was selfish, he said it was not selfless.

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Better whack himself in the head with a cactus instead?

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My hypothesis is similar but somewhat different:

1) They understand on some level that donating a kidney is a good thing to do.

2) But they don't want to do it.

3) They're worried that if it becomes normalized they'll feel unwelcome pressure to donate themselves.

4) They expect that other people donating will tend to make it more normalized.

5) So they come up with reasons to discourage other people from donating.

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No, we don't think it's a good thing to do!

and I don't really care about pressure on me - I'd just laugh and tell them my organs are mine only - but I worry about pressure on others who might be suckers for that type of campaign.

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Okay, maybe some of you are just in favor of people suffering and dying from kidney disease ¯\_(ツ)_/¯

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No, but we don't think donating is right.

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Nov 9, 2023·edited Nov 9, 2023

It's obviously very good for the receiver, and at least somewhat bad for the giver.

There are then 3 possible positions:

1) Who cares about the receiver, I will do what I please with my own stuff. Generosity and selflessness is what you teach to children and people you want to profit from.

2) Utilitarian position, where the total amount of happiness needs to be maximized. As all utilitarian computation, it's tricky because the cost/benefit is tricky in itself(per year? weighted differently depending on your age? Happiness as reported? Also, if you weight somewhat more the happiness of the giver/chooser than the receiver, is it still utilitarianism? At some point differential weighting will become (1), but without it I feel utilitarianism is so fringe it's purely theoretical...

3) Utilitarian with "reasonable" weighting and taboo for protection against manipulation.

I think (3) covers the vast majority of people, including me. Weighting differ a lot (I weight closer to (1) than most I would guess - i.e. I'm selfish bastard). Taboo not so much, they are more societal than individual, and in western society body integrity and self-ownership is such a taboo. Scott think the taboo should be lifted for organ donation, I do not think so cause taboo are there to protect about common utilitarian derives: they remove the pressure for close to equivalent weighting (not so many people admit being selfish) and they also prevent cost/benefit manipulations. Also, once a taboo is removed the behavior enter the marketplace much more easily (another reason for taboo). BTW the taboo was already semi-broken for COVID, so it's not like it is watertight right now...

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What do you mean about taboos and covid?

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Vaccination that was for protecting others, and with enough pressure it was almost mandatory. This combination is AFAIK a first, and in conflict with the medical principle that say the patient is free to choose treatments in HIS best interest.

It's very interesting to compare societal response to covid and to aids in the first years it was identified.

In fact this seems like a great idea for a sociology study. It will be hard to do objectively... But that's the norm in sociology anyway. It's a book I would buy in a heartbeat if it's done with even a minimum of effort and talent.

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We have historical records of the founding fathers pushing for mandatory primitive smallpox inoculations specifically to slow the spread of the disease. Vaccination was always about protecting other people.

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I propose the alternative assessment:

1) They feel scared of the idea of donating a kidney

2b) They do not want the societal pressure for donating a kidney to increase, because pressure for anything you do not want to do is a net worse for you, by definition of "pressure"

3b) They have a fair amount of pessimism and memory, so they take the precedents of change in societal norms seriously: this has happened, it can easily happen again

4) They are intelligent

5) They use their brainpower to come up with a reason for why it is logically unwise to donate a kidney

6b) Now that they have a logical reason for their aversion, they can use that to attempt to stop societal moral shift towards "donating a kidney is the right thing to do"

I do not know if it's more accurate in general. But it is in my case;)

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There's literally never going to be social pressure to donate a kidney. That's not really a concern.

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Really? What gives you such confidence? I'm genuinely interested, it's unlikely that any of us will change his mind, but I'd like to know what makes you believe kidney donation will remain off the table as an altruistic thing to do in the future (let's say 30y to keep the question reasonable)

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I didn't say it was off the table as an altruistic thing to do. I said there wasn't going to be social pressure.

For one thing - it's absurdly inefficient. Donating a kidney means you're out for possibly weeks, unable to work or do anything, and you have significant lifetime health risks. And for what? Giving one person a few more years of life, and maybe a couple others due to chain effects.

You can save more lives by donating a few hundred dollars!

I don't know if you've ever had any type of surgery before, but I can tell you that after both an appendectomy and a spinal discectomy, I was out for about a month and couldn't do anything. At all. People don't recover from surgery quickly.

So the absurd inefficiency is one issue, and long-term health risks (which Scott significantly minimizes) is another issue.

Another is that there's a huge social and moral norm in favor of bodily autonomy and privacy of health decisions, so general social pressure on people to get surgery is just not going to happen.

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Nov 13, 2023·edited Nov 13, 2023

Absurdly inefficient is a plus for such thing: the more visible and more apparently costly it is, the best it will advertise how good a person you are. Efficiency has little to do with the pressure do comply.

Possible long term and irreversible health issue is why I am not even considering it, but the main point of Sott's post is to refute it exists, for most. This surprised me cause Scott do not speak OohA... So even if it's wrong it's very convincing with current medical knowledge... Meaning extra dangerous 😅

Agreed on last point, it's the main barrier and why I think it makes sense as taboo.... But it's clearly under attack (at least it's clear to me) and I see it as much more fragile than you do, apparently...

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"modulo the appendix"

The appendix is actually useful! Apart from its function as a lymphoid organ, it helps maintain regular gut flora - particularly after a bout of diarrhea. So ... keep it if you can. Maybe even give it a pat on the back, or a 'Good job, appendix. Keep up the good work keeping me healthy!' every now and then.

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I have hereby been educated! Thank you, my heuristic that things in my body are there for a reason is now reinforced even further.

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I feel like most of the body's 'mystery' organs/tissues are immune related. Thymus, bone marrow, spleen, lymph and lymph nodes, tonsils, omentum.

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Now to figure out what the gall bladder is for...

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Storing bile (a substance used to absorb fats)? People after gallbladder removals need to try to avoid eating too much fat at one time, or it can lead to stomach upset and fatty diarrea (more so than it usually does, anyway).

You can still eat *some* fats, since the liver makes the bile and can excrete it into the intestines, but without a ready reservoir of bile, it's less able to handle large, fatty meals.

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Bonus Points to anyone who can name what the thymus does without looking it up.

Hint: it's critically important to survival, to the extent that babies born without it die within the first two years of life (if left untreated), but if it gives you problems later in life you can totally take it out and be just fine.

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Immune cell production - you can survive it’s removal as an adult but it does weaken your immune system.

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That's worth 5 bonus points. Naive T-cell maturation and negative selection. The thymus has the only cells in the body that express every protein in the genome.

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According to Wikipedia, mTECs express about 85% of genes in the genome, rather than 100% as you state here:

https://en.wikipedia.org/wiki/Promiscuous_gene_expression

Is this incorrect?

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Thanks for the correction. It's been a few years since grad school.

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I knew this one from Cells at Work - it filters out T-cells that attack your body or don't attach to the right receptors. (In the show, it's depicted as "boot camp" for T-cells.).

I didn't know you could remove it without problems, though.

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The thymus is a place for T-cells to mature into naive cells. It's where they rearrange their TCR genes to form the final TCR. You probably know this from Cells at Work (never heard of it, but if they're teaching immunology they must be all right), but any T-cell with a T-cell receptor that recognizes 'self' antigens commits seppuku. The 'boot camp' analogy is pretty good here, because soldiers all go there, and once you graduate you don't come back. Same with T-cells once they've matured enough to leave the thymus.

Now, if you're born without a thymus, you die of infection. I've known researchers who worked on mice they thymectomize neonatally, so the mice don't start out with T-cells. They have to house the animals in a germ-free environment. This is nearly identical to X-SCID, or the famous 'bubble boy' disease.

So why can you survive without a thymus? Isn't that the same as trying to survive without T-cells?

T-cells live a long time after they're released from the thymus. It's best to be able to continue producing them, but after you get that initial stock of T-cells a few months after birth you'll mostly be fine. Maybe you won't be as robust at fighting infections, but you're not completely defenseless. Plenty of soldiers already graduated boot camp. This is why the researchers I mentioned above have to operate on little baby mice to remove the thymus, because if they wait until the animals are big enough to make the procedure easy, the mice will have at least a few million circulating T-cells and the experiment is ruined.

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I'd love to know if people who have strong negative feelings about this also feel strongly about not switching tracks in the trolley problem.

Like it's always seemed crazy to me that people care (aside from pragmatic concerns) that the donor might regret the choice. Ok, they regret it but I bet the recipient would regret it not having happened any more.

One hypothesis is that they see there to be a higher moral bar required to make changes from the status quo...hence the trolley question.

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I don't plan on donating a kidney and I'm the kind of guy who makes 'multi-track drifting!' jokes about the trolley problem. Not sure this clarifies anything.

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Yah, but are you the kind of person who sees someone else doing it as kind of suspect or worries about them making a bad choice? I don't think I'd donate either but just because I'm a bit too selfish relative to my expected cost but the idea that someone else is making a mistake in donating seems like a crazy thing for a society to worry about to me (we let people make all kind of dumb choices and in this case any regret they feel will be balanced by the benefit to the recipient).

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Interesting question, and I think I too-narrowly interpreted the 'this' in your "people who have negative feelings about this". I was just responding to the kidney donation itself.

As for how it feels to listen to someone positively describe making a choice that feels repugnant to me, I experience it as a kind of skepticism, but not one that I'd confabulate about in terms of scams or cults or future regrets. My brain is just doing the same thing a child's does when you're trying to trick him into eating grass or a leaf or something as a joke and he's looking at you with his little eyes narrowed.

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I guess I'm trying to ask if you feel that thing Scott called a kind of altruistic concern about other potential kidney donors?

Like if neither the donor or the recipient have any relation to you is your concern about the donor potentially regretting the choice or making a bad one or with the person who needs a donation?

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It's more a sense of wishing people wouldn't make the world uglier by having kidneys removed, or by developing kidney disease, or by developing type-two diabetes, or whatever. It's not altruistic, as I don't feel that way about things anymore. It's maybe aesthetic. The original commentor talking about bodily integrity was putting words together in ways that gave me the sense that I knew where he was coming from, but he was already being dogpiled and I didn't want to jump in and say "you're not really talking about morality you're talking about aesthetics, welcome to the dark side."

On another level, for the record (I'm not a monster), I think there's a bizarre kind of beauty to situations such as someone donating an organ, or two parents drowning in a plane crash while pushing their paralyzed daughter and her motorized wheelchair out of the sinking plane (even though from a position of reproductive fitness they'd have been better off drowning her at birth and having more kids that hopefully didn't have cerebral palsy and might reproduce). Oh brave new world, that hath such creatures in it!

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Ahh, I don't share that feeling here but I don't find it particularly puzzling. Like I could totally imagine some kind of altruistic surgery that left the donor with some kind of disgusting deformity (yah I know it would be better if we didn't feel disgust at these things but let's be honest we do) and having that kind of feeling.

What I find puzzling is someone feeling particularly moral feelings about the donor. I mean I don't think that those comments are motivated by a kind of integrity aesthetic like you describe but rather by some greater salience of the donor's outcomes than the recipient's.

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I tend to think that moral judgments are in fact aesthetic ones; unfairness is ugly, for instance.

so talking about morality is talking about aesthetics.

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The difference is that we let people make dumb choices that might benefit them or help them in some way, for them, but this is one that hurts them for the purpose of benefiting someone else, which is worse and more suspect.

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what are multi-tracked drifting jokes?

My favorite trolley joke is "You can throw the lever and save five people's lives, but then you can no longer fundraise off the situation."

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You switch the lever in such a way so that the front wheels of the trolley are on the first track, and the back wheels are on the second, killing people on both

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I approve of this solution to the trolley problem and am going to steal it

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Which side are you on in the trolley problem? I wouldn’t switch tracks because it is an action, caused by me, to kill somebody.

(Unless of course I was saving loved ones).

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Nov 7, 2023·edited Nov 7, 2023

I wouldn't say I have negative feelings about organ donation at all, only about the utilitarian reasoning used to obligate it. But yes, I'm generally against turning the trolley, for two reasons. First, the difference between an act and an omission (which seems so overwhelmingly intuitive, AND so central to human thinking about basically everything, that I'm amazed people can deny it so easily). And second, treating human lives like commodities to be weighed against each other in a calculation. *Ideally*, I'd say a human life is of infinite value, and thus five infinities are no greater than one. Admittedly, this feeling breaks down if I raise the number (on the original track) sufficiently, but it holds fairly strongly at only five.

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I fully agree, act/omission seems to be an intuitive moral distinction most people hold, one that I certainly share, and utilitarians have been fighting an uphill battle against it for centuries.

There's a principle in law called "duty to act". Generally if you walk by a man stranded in a pit, you have no obligation to help him out even if you could do so easily and safely. But if you induced him to enter the pit, say to retrieve some item, and the ladder broke on his way down, now you have a duty to act because he relied on you explicitly or implicitly. I think that's a pretty good baseline for when an omission acquires a moral valence. It also works to justify why people would spend $X to save their child but not 1000 foreign children at the same cost, or save their spouse but not 1000 trafficked women in some distant land. There is an implied duty to act created by having a child, or maintaining a relationship where you reciprocally help each other on a daily basis, but a stranger in a foreign land has no reasonable expectation of such aid.

It seems like it would be basically impossible to live with Peter Singer values where every decision had a moral valence. The ability to shrug and say "eh, not my problem" is essential to a sane life.

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The key for me is just the ability to be comfortable with falling well short of the ideal standard of virtue. I think most people fall short of ideal virtue by their own standards anyway, so to me raising the standard further doesn't make a big difference in how I feel about it. And no ethical tradition I've ever heard of says it should be *easy* to do the absolute right thing in every single situation throughout your life.

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Yah, I don't personally share the act/omission intuition (indeed feel the opposite) as a matter of actual morality. But that's just because I just believe in a partial order on choices -- some are better than others and not the notion of a moral obligation.

Of course, that background moral framework then entails we should have social norms which may in fact have an act/omission distinction but those norms aren't themselves the moral reality just a hueristic to help make society behave better (kinda analagous to how the fundamental physical laws can incorporate symetries that end up practically broken).

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I have a hard time conceiving of an ethics that isn't based in a system of moral or social obligations. Perhaps it's because I went to law school and so that's the framework I was trained to think within, but I did minor in philosophy and took ethics. If I have a choice between A, B and C, and if I have not put myself in a situation where I'm obligated to pick one over the other, than my choice has no moral valence at all. It's just a preference, a flavor of ice cream.

If I had $100 of extra money, I could:

1. Donate it to some anti-malaria project in Africa

2. Buy several cases of fast food tacos and pig out on them all weekend

3. Buy new walking shoes that will ease pressure on my ankles, marginally improving my health.

#1 doesn't help me at all and I'll see no benefit from it but helps a lot of other people. #2 is making my life worse. #3 is making my life better in a real but relatively small way. I would put all of these choices in the "morally permissible" category, as neither obligatory nor forbidden. Peter Singer or some other radical utilitarian would say you're obligated to do #1, a virtue theorist could say you're obligated to do #3, and both the virtue theorist and a divine/natural law theorist would say you're forbidden from doing #2. But I don't believe there's any *moral* sense in which you're obligated to calculate which of these is better and do it, morally the decision is no different than selecting which Netflix show to watch with your wife on the couch tonight. It's nobody else's business.

I agree that the social norms we adopt aren't the real underlying moral reality. We certainly want to discourage #2 above since hedonism is costly to society in the aggregate, but I can't point to any moral obligation NOT to pig out on a wheelbarrow full of 100 tacos for $100 this weekend. I just think within the realm of "neither obligatory nor forbidden" lie most of our decisions, and that it however you rank them among the infinite options available to you, that doesn't make any one of those choices moral or immoral. But if pressed I think we'd try to justify the norm against hedonism with reference to e.g. the socialized cost of medical care for obesity, and make an implicit obligation argument. Since the purpose of having a concept of morality is social, it makes sense for it to revolve around social obligations and be confined to the sphere of activities which concern your obligations to the community and those you transact business with.

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I'm not sure about Singer but not all radical utilitarians would say any such thing. Some would simply say: it would be morally preferable to do 1 and second best to do 3 (assuming u don't really love tacos). Obligation talk isn't a necessary feature of a moral system even if traditional nor do you need a notion of blameworthy or praiseworthy. It's enough just to say this would be better than that.

And I guess I'm pretty confused about what you are saying later. Like what we mean by morals are those things that ultimately ground out that chain of 'why do this'. Philosophically moral reasons are often taken to be those with the property of being inherently normative (eg a moral reason inherently explains why you should do something).

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Nov 7, 2023·edited Nov 7, 2023

I’m not sure that saying “X is morally preferable to Y” is actually meaningful unless there’s a hidden premise that you are obligated to take actions that are morally preferable. Otherwise nothing differentiates it from choosing an ice cream flavor or a TV show to watch, it’s mere preference, and you place higher value in a category of action’s you’ve labeled as “morally preferable”. Identifying a hierarchy of moral actions, without a concomitant obligation being formed, is just an indicator of what you value. Which is basically what e.g. Ayn Rand did, set a system by which you could assign values to different actions and then say it’s moral to pursue the highest one, arriving at a very DIFFERENT ranking of choices than I assume you do.

Given that it works out very well for me materially and psychologically not to care in the slightest about poverty in the global South, if you cannot point to an obligation to adopt your preferences then why would I?

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Maybe a better way to put it is: when you say the ultimate purpose is social (and I think there's a conflation here of what rules we follow with what is objectively true) what ultimately makes that the correct purpose to pursue? Why care if the species dies out or everyone ends up miserable at all in the first place. At some point you need to ground out.

TBF I alternate between describing myself as an extreme utilitarian and a moral anti-realist since I don't really think there is much distinction between the two as I understand them given I don't believe in personal identy. Like I don't believe that someone who has coherent but 'wrong' moral views is making a mistake about logic or the way the world works....I think that they'd have to be quite odd to hold that belief under sufficient reflection.

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I definitely disagree with most of this. Ethics is about the highest good and making the most of your life and resources - it's not social, and what you do in private may not be anyone else's business, but it is very much an ethical question.

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If it's not social at all, what are we jailing people for? Sure, there's a private aspect, but you can't infer that public morality doesn't exist from the fact that private charity does exist.

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Having clearly defined shalts and shalt nots is a good justification for societal punishment. For some reason, rationalists only think in terms of private charity. Which makes it easy to overlook deontology.

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Destructive choices where the cost falls mainly on the chooser are often a relatively low priority for moral reasoning and societal enforcement, because one way or another the problem will usually solve itself - either they'll learn from mistakes, or persist and eventually be rendered irrelevant by attrition.

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So do you never drive a car, then?

If a human life is of infinite value then we should never take any risks whatsoever since no risk could possibly be worth the chance of someone dying.

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An analogous difference of views: I've always disliked it when economists characterize reduction in your taxes as the "equivalent of a subsidy". It might be in terms of resulting incentives, but to me getting to keep more of the money you earned is not the same as getting other money from others' taxes. If taxes are something the state is entitled to, then any giving it away, be it to the original payer or someone else, is equivalently bestowed by the state.

It's kind of like that. It's different if taxes are viewed as someone's property taken as a necessary evil to make the state function.

Likewise the kidney. The recipient might regret not getting a kidney but they don't have a default entitlement to someone else's kidney; they get that through the donor's generosity; the donor doesn't have an obligation to give his kidney. If people are afraid of the coercive effects of organ markers for money, well, any other correct effect is bad for the same reason.

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TBF to economists they aren't making a moral judgement - they shouldn't be - and they are talking relative to a background taxation system. Indeed, usually I see this language used to justify why you should just cut someone's taxes rather than establish a subsidy program for them.

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I'm a lot more concerned about the donor's situation than what happens to the recipient!

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But *why*??? I assume you are speaking as a moral matter not based on some kind of professional responsibility.

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because hurting your own future is worse than hurting someone else's

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I don't know if I have "strong" negative feelings about kidney donations like Scott's but it certainly creeps me out. And yes, I have very strong feelings about the trolley problem. I am deeply, viscerally suspicious of anyone who would Sacrifice their mother to save a thousand strangers' lives. That feels like totally alien behavior; ruthless and so strange that I have no idea what to expect from that person.

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I care a lot about the donor regretting it because it's a really big decision and people being talked into really big decisions that they regret later is a big part of how people start to feel swindled by every interaction with society, and that contributes significantly to making everything worse.

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I appreciate it's a big decision, but it's a huge benefit as well so why are you more worried about how the donor feels? And what about the sense of the donor and their family that society doesn't care about them?

And even if we took far far less care it would be more care than we take with many other choices people can make. Marriage is a huge choice but we don't even have a waiting period. And even when you consider choices like getting a tattoo my sense is that people don't feel swindled unless there is some substantial pressure or inducement.

I'd find your objections pretty strong relative to a society where there were constant messages shaming people for not donating but if anything it feels like people get stronger messages to be careful and recommending not to do it and pretty much no pressure from outside to do so.

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Nov 28, 2023·edited Nov 28, 2023

I want to be clear that I'm not against organ donation, even if some amount of donors regret donating. What I instead am saying is that I weigh donor regret at many times what I weigh recipient suffering at. I don't know the exact number, but it'd have to be at least one to ten before I even started considering it.

To answer your marriage comparison, I would very likely be in favor of some amount of waiting periods and mandatory family counseling before people commit to legally entangling their finances and rights. Lots of people who get married regret it and feel like they got swindled, and that's very bad for society. I also think that donating a body part is a much bigger decision than getting married, because people get divorced all the time, but no one gets their donated kidney back and it's not significantly replaceable unless they end up in a life-threatening situation of having no kidneys.

Society runs off of people making sacrifices for the benefit of others and feeling that they can trust institutions to inform and prepare them for said sacrifices. Society does not run off of people's expectation that sacrifices will be made for them, unless that's reciprocal for some prior similar sacrifice they've made.

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I understood that and I appreciate it, I just don't see how you get from the issue of trust to that of weighing mistakes in the fashion you do.

In particular, what seems corrosive to the trust you mention is the feeling that you've been dupped or conned not that you've made a bad choice. So I agree you've made a strong argument as to why there should be a whole bunch of places where we stop and go "are you sure you really want to do this, you can say no at any point and it's fine" but it seems to me that's a different thing than throwing barriers in the path and essentially treating the values and choices of the person who wants to donate as somehow less valid (we don't deny people control over their body because their anxious otherwise) or as less important to respect by putting a thumb on the scale against letting them do it rather than merely making sure they express them consistently over a long period without external pressure and plenty of time to change their mind.

So I think I agree about the general structure, but I'd draw a distinction between making extra sure the person doesn't feel pressured or rushed into it and making sure they aren't making a mistake. It's only the former that has the externalities while if they make a mistake despite being given every option to go the other way I don't see why that's the same kind of problem.

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In trying to think this through, I'm trying to imagine the kinds of mistakes one could make regarding organ donation.

The first I can imagine is someone insisting on going forward despite a medical consensus that their donation will very likely not be usable. I would generally want society to prevent this or at least gate it behind a much greater wall of bureaucracy than in the alternative.

The second I can imagine is that there's a medical consensus that the donor will be unusually harmed by the process, where I could see some kind of scale being employed based on the amount of harm suffered. Inflicting significant permanent injury on one person to give relief to another is something I would want society to be pretty reticent about.

The third kind of mistake I can imagine is some kind of psychological mistake, like a feeling of intense guilty compulsion or a fit of mania. While I think that some institutions are clearly going too far with this, if I had a family member with these psychological conditions who read this blog and suddenly felt compelled to give a kidney and I knew they'd regret it later because that's just how their psychology works, I would want society to hit the brakes on that. Especially because these conditions might make them ignore the first two problems.

Maybe I'm just comparatively a nanny-stater, but that's where I end up. Organ donation is a big enough departure from normal human behavior and a permanent enough sacrifice that I want to be super extra sure that people are doing it for the right reasons.

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Lots of people said you wouldn’t have two kidneys if going through all that effort to grow two wasn’t important

But isn’t having two of a thing just down to us having bilateral symmetry?

Is there any feature in our body, that has been suppressed such that we don’t have two of them as bilateral symmetry would dictate?

The heart is the only thing that comes close that I’m aware of

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liver, spleen, gallbladder, stomach, intestines...lots of abdominal organs aren't bilaterally symmetric.

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Nov 7, 2023·edited Nov 7, 2023

The organs that form along the gastrointestinal tract couldn’t be bilaterally symmetrical if they wanted to.

I’m referring to organs that would be developmentally expected to be bilaterally symmetrical but aren’t due to pressure against the cost of having two when one will do

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Hmm I don't see why not? Why couldn't we have evolved to have a stomach that runs down the center of the body rather than being tilted to one side? If other organs would be in the way, why couldn't it split in 2? (I admit this is harder to imagine for the intestines).

To speak more to your point, when it isn't a question of how the organs could fit in a reasonably-shaped body (and we assume radically different body plans either don't work as well or are too far of an evolutionary jump), my suspicion is that it's much easier for two copies of an organ to shrink or otherwise become less metabolically active than for a new asymmetry to develop (requires a gradient of signaling molecule to be expressed at the right time during development, for the right developmental processes to depend on this...) Blood filtering is a great example of a process that works well in parallel, so it makes sense that it would stay bilateral, just by evolutionary default rather than necessity (also blood oxygenation, for the lungs).

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- lungs: unequal sizes of the right and left lobes

- testicles: the right one receives less blood flow because of how the artery feeding them is laid out. It is physically smaller, can be non-functional, and has higher rates of cancer.

- hands: we have one dominant hand, presumably because high + low skill is better than medium + medium skill.

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As testicles got mentioned: maybe I could do with two "one-eyed-snakes". Wait, ONE eye? https://www.youtube.com/watch?v=p9PiqCeLEmM (funnier with subtitles switched on)

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I've read that the left testicle is lower in 90%

of men - is that related?

do the other 10% have a smaller left testicle? Or is the right smaller in everyone except those rare people with mirror-image disease?

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Another question for those who generally are skeptical of donating a kidney. Imagine we can return kidneys to the initial donor and someone who donated a kidney runs into trouble and needs a second kidney. Do you feel similarly skeptical about the kidney recipient donating the kidney they recieved back to the original donor or do you feel that's presumptively ok and we don't need to carefully check they won't regret it.

In other words is the feeling about some sense of ownership of your own body (so returning isn't as suspect) or is it about the change relative to the status quo (or other I guess).

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Very clever question! Yes, it's about ownership of one's body. I don't have the same concern for the recipient; indeed, I feel like they're obliged to give it back.

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Interesting, my feeling of ownership is part of what makes me react so strongly against all the precautions and barriers put in the way of donation. It's my fucking body and life, how dare you impose your values about how I should weigh various outcomes on me. Though I dunno if this is a per se moral belief but it is my strong moral reaction.

Sure, it's fair to make sure I'm of generally sound mind and it's not a momentary fad or done under threat to my life but by making it an onerous process you are forcing me to weigh my concern about donating when I shouldn't more heavily than not donating when I should (the fact that I might not feel bad in the later case is no more an excuse than the fact that I might be ok w/ it after u inject me with a narcotic is an excuse to do it w/o consent).

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Yeah, if you're not allowed to deliberately damage it, you don't really own it. Doesn't seem like that should be controversial. https://www.schlockmercenary.com/2010-01-03

https://www.questionablecontent.net/view.php?comic=4176

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Yah, on reflection I guess I feel more outraged by the feeling that my authority/control over myself has been violated and to me putting a heavy thumb on the scale I might disagree with feels very much like such a violation.

I didn't realize that was part of my intuition but it is.

Indeed, the more I think about it the more I realize all those extra barriers makes me feel (I don't want to donate bc health etc but if I did) that I'm being disrespected for being different.

Like everyone would understand why it would be bad if we made elderly people pass a whole bunch of psychiatrists/boards to opt to continue living rather than be euthanized and the emotional feeling to me is that because I don't share the same values as everyone else it's seen as ok to try and use coerciveish pressure to get me to give mine up.

Weird didy realize I felt so strongly.

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No one's asking you to give your values up; rather, you're asking other people to go against their values, by operating on you and facilitating your donation. You're not the only one involved here - you can't do the donation on your own.

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Not at all. Of course any individual doctor should be able to choose to not operate on whoever they want. The difference is that if a doctor who shared my values said: yah go ahead, we'll do a basic quick screening make sure your still into it in a month and then go for it they'd be, if not outright called up for an ethics violation, at the very least be denied access to the transplant list and effectively legally prevented from performing transplants.

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Do you have any evidence for this claim? Has this ever happened to any doctor?

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Well unlike any normal surgery transplants must be approved by the hospital transplant coordinator and the hospitals demand they apply this procedure. Unlike a normal procedure where you mostly just get the surgeon onboard and he gets to roll. If the surgeon ignored thaf rule they'd certainly lose privileges.

So in *some* sense it may be voluntary at the level of the hospital (tho I think they can be kicked out of the registry) and I don't know what would happen if a whole hospital said fuck this system but see. my other comment about thr limit of volountarness in the face of coordinated pressure.

I suspect that's just the tip of the iceberg but thats at least clear and verifiable.

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But to be clear this is just my aesthetic reaction and independent of the moral issue. I don't really believe there is a moral responsibility for this to be symertric it just insults me and I think it's a bit inconsistent with what the bioethicists claim to believe but whatever.

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Let me put it more bluntly. If it's just about the doctor's moral views then you'd not be at all upset if someone like me became a doctor and used the same level of pressure to convince potential donors to rethink their decision to convince anyone with healthy kidneys who doesn't want to donate to do so.

Maybe this doctor even says, you know if you don't want to donate you'll either have to find someone else to be your doctor or go see this psychiatrist who will push you to make sure you're certain about not donating and aren't doing it for 'suspect' reasons like pressure from family or religion (and if you are you either need to commit to try and overcome them or I'll drop you from my practice).

That would be equivalent treatment on the other end. Now imagine that almost all doctors feel that way and they pressure others to fall in line. I bet you don't think it's as unproblematic that they are all just exerciscing their own moral preference not to treat anyone who is healthy yet seems opposed to kidney donation. Yet in coordination they make it extremely unpleasant and difficult -- but not impossible -- to avoid approving the donation.

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It's clearly not symmetric - donating causes harm to the donor. not donating doesn't.

And docs pressuring patients is not ok, whether it's pressuring them to donate, or not to donate. But they and other medical staff have no obligation to go along with your wish to donate, and they have their own interests to consider, like preserving the system. If word got out that a bunch of people donated and regretted it, it would harm the whole system.

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Not donating results in worse harm to the prospective recipient.

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The point is that I've been denied the choice to determine what constitutes harm to me.

Look, if we said that getting a vaccine is a benefit and doesn't impose a harm so we don't need to respect a refusal to give consent (or doctors could all collectively decide not to treat people who refuse vaccines) then it would be symetric. But we let people who don't want to get vaccines for religious or moral reasons decide that's in their best interest and respect it.

But when it comes to the kidney I don't get to choose what constitutes a harm to me. Hell, maybe I just fucking hate having 2 kidneys inside me why isn't that a harm.

Either we use an objective test everywhere and tell the vaccine refusers it's not a harm or we let people decide for themselves what's a harm to them.

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To be clear the asymetry is the fact that some people get their arbitrary ideas about what constitutes harm respected (christian scientists get their belief that medical treatment harms their relationship with god respected) but ok can't decide that my moral concerns get to dictate what constitutes harm to me.

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To calibrate your risk of chronic pain better, you should ask your surgeon the rate of chronic pain their patients experience.

Indeed, this is a good practice for any surgery or other procedure that produces complications. Who cares if 1 in 5,000 people nationwide have their face go numb as a result of some dental procedure. If my dentist makes 1 in 50 people's faces go numb, then I start to worry!

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That's a good point. Unlike drugs, surgery varies a lot depending on the doctor. But I don't expect most surgeons to have good data to answer the question. Do you?

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They're required to give you the general statistics, but as you guessed, they're not required to keep their own stats. Usually you get an answer like, "I've never had that happen, personally. I try to avoid it by ... "

You want to get a surgeon who's at least above average, but of course that means there are those who are below average and all along the distribution. If the physician tries to reflect from personal numbers or seems uncomfortable talking about it, that may be an indication to look elsewhere. You don't need an exact percentile to make an informed decision.

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Nov 7, 2023·edited Nov 7, 2023

What if donating a kidney isn't altruistic, but instead, a sensible, self-interested way to bump yourself up to the top of the kidney donation list if you ever need it? A positive-sum cooperation game where the donor and donee both benefit.

The stories from people who had kidney failure made think, "what if I have kidney failure one day? Man I hope someone will donate to me"

Then I remembered how apparently donors get bumped to the top of the donation list in the future, should they ever need a kidney...

Maybe for that reason alone, donating a kidney is actually selfishly the most healthy thing to do? If you donate, you go from two kidneys to one, and thereby have a greater risk of needing a donated kidney yourself. But you *already* have a background risk of needing a kidney one day. And if donating now can be a protective factor for that, in that you'll be bumped to the top of the kidney list if you ever need one, it sounds like opting into slightly higher risk of needing a kidney in the future in exchange for insurance that if you ever lose a kidney, you'll be just about guaranteed a donor!

It makes donating a kidney sound less like a highly altruistic act and more like a sensible way to opt in to positive-sum cooperation game.

If this were true then publicising that message could encourage donation maybe even more than a message "you'll be a wonderful person".

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I did have similar thoughts when I donated. Its really a solid benefit of the whole thing

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I think the additional relevant datum would be that one's kidneys DON'T fail independently. (I don't know if it's true; if not, your argument fails.)

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Nov 7, 2023·edited Nov 7, 2023

Yeah, agreed. GPT-4 says,

"The failure of one kidney isn't necessarily predictive of the failure of the second kidney, especially if the cause is something isolated to one kidney, like trauma, cancer, or an infection. Your kidneys work as a pair, but they don't necessarily have to fail or function together. A person can live normally with just one functional kidney.

However, if the kidney failure is due to a systemic disease such as diabetes, hypertension, or polycystic kidney disease, the chances of the second kidney also failing are pretty high. This is because these systemic diseases affect the entire body rather than just a single organ. So yes, from this point of view, one might argue that kidney failure could potentially be predictive of the failure of a second kidney, but it highly depends on the underlying cause.

Even so, predicting the potential failure of the second kidney isn't straightforward and involves many factors, including the specific disease, its stage, how well it's managed, the health condition of the patient, lifestyle, and the presence of other diseases. Regular monitoring and medical check-ups are vital in such cases."

which sounds like RLHF-speak for "no they are not independent"

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GPT isn't any kind of authority and is unlikely to be accurate on these things. Its answers are full of hallucinations.

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This is definitely true

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lol. "I'll give up a million dollars - that way if I ever need a million dollars, someone will be more likely to give it to me!"

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yes, considering that you have some baseline risk of losing your million dollars (kidney failure) and you can insure yourself against that by giving up *half* your stock of kidneys in exchange for a promise of a new kidney quickly if you need one.

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that makes no sense at all. You're giving up your spare parachute in case you ever need it so someone can give it back.

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In the parachute analogy, you could quite possibly be in a scenario where *both* parachutes fail, and then you're screwed, unless, ahead of time, you've obtained a commitment from someone else to give you a spare.

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This doesn't make sense. The price of obtaining that commitment to get a spare is to give up your own spare. So at best, you break even.

In fact, your own spare is a lot more likely to work for you than the transplant. Transplants are not perfect and sometimes your body rejects them.

Not to mention that getting the spare requires anaesthetic and surgery and there are risks inherent in that.

Finally, there is no "commitment" in the kidney example. They'll move you to the top of the list, but that doesn't guarantee you will get one.

So you're giving up a sure thing (a guaranteed spare parachute) for the chance of maybe getting a spare parachute later, but one that is risky and less likely to work.

There's no advantage to this plan.

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I acknowledge the complications you're describing. but I think you're missing that kidney failure of each kidney might not be independent, and there's some value in obtaining insurance against them both failing, such that in the scenario where your body goes thru some illness causing both kidneys to fail, you'll be better off if you give away one ahead of that to bump you up the queue. For your argument to be right you need to show that benefit is outweighed by the cost of giving away a kidney, which you haven't done.

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Step one, give your spare parachute to somebody else on the plane who doesn't even have a primary.

Step two, jump out of the plane, deploy parachute.

Step three, fight jetpack-wearing supersoldiers. All parachutes you're currently personally carrying are destroyed by flammenwerfer.

Step four, receive spare chute from someone who happened to make it through the fight un-flammen'd, and wants to reward you for step one.

Step five, land safely.

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I'm not sure if the selfish risks are completely offset by this, though I'd be interested in that analysis.

But also, an interesting consequence of this line of thought, if valid, is that everyone should donate their kidneys out of self-interest. But then of course that if everyone donates then nobody gets bumped up. So in the end you'd end up with a situation where you might feel compelled to donate out of self-interest not to gain extra health security but to avoid losing it. Which is not necessarily bad but I think is an interesting corruption of the initial spirit of the argument

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Nov 8, 2023·edited Nov 8, 2023

If everyone signed up to donate, supply would far exceed demand, and there wouldn't be a waiting list. So there'd be no longer any incentive to donate to bump yourself up and supply would fall back a bit. The equilibrium is that each actor looks at whatever the current waiting time is (let's say 3 years), and decides whether it's worth it for them to donate in order to get bumped up to immediate availability, given the expected wait times for being a donor or non-donor. In aggregate the supply and demand curves meet at some market-driven point, say, 3-6 months wait, where the marginal person feels like it's not worth donating to get bumped up the relatively short waiting time.

Arguably, we're already *at* an equilibrium, where the wait time as I understand it is ~3 years, except that I don't think most people have considered the opportunity to bump themselves up the list by donating. If they did, then we'd get some better-informed and presumably shorter equilibrium.

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Actually you're right, I forgot there aren't literally infinite people needing kidneys. Except in equilibrium it's not immediate availability you're getting, but rather getting to the top X% of the list, where X is the percentage of people who've donated. So after X=50 my scenario is still kind of true only much less dramatic.

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Nov 8, 2023·edited Nov 8, 2023

Because every kidney volunteer has a 100% chance of donating a kidney but probably 1-10% chance of needing a kidney, as the number of donors increases, the availability will always increase faster than the need, so assuming an equilibrium is reached with a constant rate of donors and need, every additional donor on margin improves the wait time for all donors, themselves included.

In real world I understand kidneys aren't durable, and if there was a rush of donors followed by a lull after the initial phase of the trend subsided, those donors could end up in a less favorable circumstance than they were expecting.

I suspect that's not a huge deal just because such a small proportion of donors will ever actually need a kidney.

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If we assume no correlation between donating a kidney and needing one, you should expect the percentage of people who have donated to be the same in the general population and among people needing a kidney. In fact, if you account for not only the donor but also a few of their loved ones getting priority, the benefit of donating should decrease faster than the percentage of non-donors. e.g. if 1% of people have donated, a new donor should expect to "overtake" a bit less than 99% of people needing a kidney. Now, as I said before, this will always be a small effect if 10% of people donating would completely eliminate the need for more donors. The decrease in the number of people waiting for a kidney is more significant than that

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As the waiting list gets shorter, there might start to be a significant fraction of would-be donors turned away because they aren't a worthwhile match for anyone who currently needs a kidney, resulting in a sort of reverse waiting list. Increasing chance of that would lower the expected cost of actively attempting an undirected donation, which might then make more people willing to try it, thus further extending and diversifying the attempted-donor waiting list. Conceivably that could tip over into a persistent "supply far exceeds demand" equilibrium.

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> "This isn’t selfish (they’re trying to protect someone else). It’s not exactly altruistic (it’s preventing an act of altruism which I think everyone agrees is probably net positive). So what’s the psychological motive here?"

It is a curious phenomenon. Maybe best understood as a kind of co-operation with the other agent (qua rational agent)? I could see Kantians thinking this was the appropriate way to respect their status as a rational being and end-in-themselves. Or you could frame it as an application of the Golden Rule: Just as we'd want others to warn us off from *excessive* altruism / self-sacrifice, so we should warn off others that are about to make such a (putative) error.

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I fall roughly into the category of being a "discourager". Two arguments off the top of my head:

- Shelling points. If you want to keep supererogatory things supererogatory, there should not be *any* pressure towards doing them. You can observe this for example when doctors want you to release your data for a study. They hand you a form, and leave it up to you to sign or not. They won't elaborate further. This is important because these people can potentially keep vital medical resources and/or information from you. You need to be able to trust that in the moment they're seeing you, they're optimizing for *your* good and no-one else's. While I share some of Scott's skepticism towards bioethicists, I note that the term is starting to be used as a boo-word in the rationalist community. But ethical questions around medical care are indeed often subtle and tricky. The reason I call this a Shelling point is because it's very easy for you (generic you in a more casual setting) to commit the same sins the doctors are explicitly isolating themselves from. Namely, to convince yourself that you're acting in the best interest of person X, but in the back of your mind you have a conflicting goal subtly nudging you away from that.

- As a matter of fact, people routinely give in to social pressure and do things they didn't *really* want to do. There is a certain amount of time and personal space needed for ideas to fully bloom. For the person to appreciate all the implications on a visceral level, to have listened to their inner objections, to feel fine about the small possibility of very bad outcomes. Social pressure from others impede this process and generate a more superficial consent motivated by social approval and other more fleeting feelings.

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The second argument presupposes the puzzling phenomenon -- that you care more about avoiding merely "superficial" consent (and ensuring that people only act in ways that they really, truly want to) than you do about saving others' lives -- rather than explaining it.

fwiw, I'm totally comfortable with pro-social pressure nudging people to behave in better (less selfish) ways than they would otherwise want to.

The first doesn't seem relevant. No-one advising altruistic self-sacrifice is pretending that it's in the best interest of the sacrificer to do this. Nor is it the case that there are rule-utilitarian reasons why we need to be able to trust that people discussing ethics on the internet are optimizing for *our* good rather than the impartial moral good.

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I care *much* more about avoiding pressured donations than I do about saving lives. It seems fairly obvious to me that it's far worse that someone was pressured into donating than that someone's life was saved - they were going to die of kidney disease anyway.

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I'm with JC to some extent. The first issue is that as a principle, "it is okay/necessary to pressure people into doing a good thing" has no natural limit in scope, neither in the category of "good things" to do or in the methods to pressure with. Especially so with utilitarians who disregard act-omission distinction, because then any and all possible actions you take, 24/7, fall in the purview of utilitarian calculus. A proponent of such society is scary in the same way as someone who takes the naive Kantian categorical imperative "one must not lie" very seriously without any consideration for exceptions. A society organized on such principles sound more than a bit dystopian.

Second issue, related to above, but a more specific special case: It is laudable moral action to do acts of extraordinary heroic self-sacrifice in an extraordinary situations. However, when it becomes commonplace to demand extraordinary self-sacrifices and chastise people not sacrificing enough, it seems something is off about the situation. Suppose there is an accident of some kind and people will die, unless one individual does a heroic action at a considerable risk to their own well-being. (First writing this, I was imagining a factory where dangerous chemicals or heavy machinery are handled, but I realized the situation generalizes to many kinds of emergencies). It is laudable for a random Joe or Jane to step in and take the responsibility of doing the heroic thing at risk their own lives. However, it does not seem a right thing to take this granted, design factories where accidents are expected to constantly happen, and demand that every worker from now on is to regularly, constantly make heroic sacrifices to mitigate them. Sounds like something like a punchline from sardonic joke from Soviet Union.

Continuing that thought ... if the accidents are unavoidable, it seems more okay to demarcate the task of "responding to dangerous situations" as a job someone may volunteer for. You may choose become a firefighter or other first responder who are expected to go in to dangerous situations. It seems OK to also to run adverts to recruit more firefighters if you don't have enough. But it seems to iffy to *demand* a random citizen standing around to run into a burning house and save any people inside.

(Afterthought: it doesn't seem that much to demand the bystander to call the emergency services and maybe learn basic first aid. I suppose the ultimate question is kidney donation more like learning CPR or more like firefighting.)

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It's good if one hero charges into a fire to reach the emergency shutoff valve, thus saving the hundred who would otherwise die in an explosion; but better still if an engineer puts in the necessary effort to design valves which take correct action automatically, thus saving a similar number of heroes over time. Simply a matter of consistently applying the same principle across different scales, as needed.

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>While I share some of Scott's skepticism towards bioethicists, I note that the term is starting to be used as a boo-word in the rationalist community.

For a while I had a similar aversion thanks to a Dean Koontz novel (ah, the follies of youth), but older and wiser I find it amusing and completely unsurprising that people doing pretty similar things hate on bioethicists. It's religious conflict, can't stand heretics!

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I read it as selfishness, generalized for strategic reasons. They don't want to donate themselves, and the more people who do the more they'll feel pressured to or judged for not, so they want to discourage others from donating as well.

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Doesn't donating a kidney exhibit a revealed preference against longtermism/EA more generally? Scott kind of touches on this in his article ("doesn't depend on a rickety tower of assumptions"), but if you think it's rickety enough to justify a non-trivial effort/cash/amount of compassion to donate your own kidney, how strongly do you really believe in trying to dedicating one's life to lowering some x-risk by 10bps? Or is this just a case of consumption, a feel-good experience whose altruistic impact is trivial compared to things like MIRI donations and bednets? My own feeling is that this is not what's going on, and people feel/think kidney donation is more important than other EA interventions because it feels more altruistic (in fact, there's a strong argument it that it is).

Separately, I would love to hear a more direct response to Kronopath's heuristic of "no unnatural interventions unless necessary." I think it's a pretty good one, and disagree with the characterization of "some studies say x but it seems unnatural so no" as "epistemic learned helplessness." It reminds me of Scott's discussion of "no evidence"--there is some base rate of things that are perceived to have "no evidence" of harmful effects that mess with the body in weird ways later being found to have harmful effects! For example, cigarettes, most of medicine in the middle ages, and so on. I think this wedge is a difference between myself and most rationalists on issues like kidney donation and circumcision, but Scott seems to view this as just pure fallacy/failure mode on my part.

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Some of the reasons "no unnatural interventions unless necessary" feels okay to me:

- Given how bad research quality is, why should I trust that there are no/low risks associated with living kidney donors? (e.g. listening to Scott and Alexandros whine about Ivermectin turned me off of pretty much any arguments in the sphere of medicine)

- It's possible to disagree with an entire world-view framing system like EA. I have updated my world-view 4-5 times since I was a teenager, am I likely to change my opinion again? Is a 25 year old living donor who reads this article likely to become more like I am at 40 years old?

- Health is a luxury. Try to convince an average-health, non-marathon running 40 year old to donate their kidney when they're already starting to see the effect of their body aging

- There are huge numbers of charlatans trying to tell us to do X because Y. I don't think Scott is a charlatan (!!!) but he is trying to convince me to do something here and I'm not buying it. The existence of people I deem charlatans who have fervent supporters among people I respect means that people can be wrong about who is and is not a charlatan (maybe me, maybe my friends), thus maybe be conservative about who you allow to convince you.

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I honestly disagree that kidney-donation is an "EA" action at all.

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in the sense that it's not altruistic? or in the sense that it's not effective compared to other things?

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It's definitely altruistic! I guess not effective compared to other things, given one believes in generally EA-coded tenets like "all lives are equally valuable regardless of place, time and space" and "we can meaningfully measure and influence x-risk down to less than one percent". Personally, I think local charity like donating a kidney are very effective, but this runs contrary to most floors of the EA tower of assumptions.

The whole basis for EA, as first articulated by Peter Singer, is (was) that you should focus less on building a local community and more on further afield moves, on the grounds that far away lives are easier to save. Of course, you could argue that this is wrong and local community charity is the most effective way to create utility. But I think that would still not be an "EA" argument, because it would mean EA is congruent with utilitarianism, when it's clearly a certain development within that school.

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Donating a kidney to a complete stranger, specific beneficiary to be determined by various doctors you'll never meet, doesn't seem very local.

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It is local. You’re donating to a local medical center, which is likely to go to a local recipient. Anything within your own US region, vs EA norms, I count as local.

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>Separately, I would love to hear a more direct response to Kronopath's heuristic of "no unnatural interventions unless necessary."

To take just one tack - necessary for *what*? What's your baseline of necessity, and is it coherent? A lot of being EA (or just A) is viewing improving the welfare of others as more "necessary" than the mainstream consensus does.

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> a lot of people insist on defining the moral law such that they are following it maximally at all times. Nobody really follows the moral law maximally at all times, so this means people end up endorsing completely crazy moral principles like “it’s morally wrong to donate your kidney”. I think it’s easier to just relax that constraint, have a flexible and reasonable view of the moral law, and admit you don’t follow it perfectly.

This seems right to me. Probably more controversially, I think it applies to a lot of rationalists with regard to animal welfare. Many are theoretically committed to the idea that all sentient experiences matter and suffering is bad, but (for whatever reason) aren't motivated to change their diet accordingly. So you end up with a suspiciously large number of people making the calculation that their (expected) personal impact on the future of the world is so great that it is morally optimal for them to eat factory-farmed meat rather than waste precious mental cycles avoiding it.

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I think many of us reflexively reject all arguments from morality but grow weary of trying to explain to people that the whole thing is some kind of goofy cultural artifact. Perhaps not 'many' -- perhaps the 'many' of this group aren't aware that they're weary of it and are trying to turn it around on you, as in the quoted commenter. I wouldn't say it's immoral to take a healthy man's kidney to give to an unhealthy man (even if consentual), but it strikes me as ugly and repugnant. I have no moral arguments to make about it, but I also don't claim to be moral philosopher. In my personal life I do what seems right to me on a daily basis, but mostly based on a gut feeling of what will sit well with me or not.

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Is it repugnant to take a healthy man's blood and give it to an unhealthy man? Or for a solvent man to donate money to a poor man?

You say that you reject all arguments from morality, but I don't see how you're not relying on moral intuition when you go beyond "donating a kidney does not seem like the right thing for me to do" to "a healthy man donating a kidney to someone who needs a kidney is repugnant." Surely morality is basically the sense that goes beyond saying "I don't want to do this" to say "one shouldn't do this."

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Don't should on yourself. ;D

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To "take" a healthy man's blood? Yes that's repugnant (without consent).

Assuming you mean it's freely given, no, because your body can quickly replace the lost blood with little harm. You can't grow back a kidney.

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I was using the language of the comment I was responding to ("take a healthy man's kidney"). In context we're talking about voluntary donations.

It's obvious why giving a kidney is a much more serious step than giving blood. I don't see why that makes giving a kidney repugnant.

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because it's too costly. It's too self-sacrificial. A person with a healthy sense of self-regard would not do it.

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It seems like some of this may just be a difference in how we estimate the cost and the level of sacrifice, but also just on our different ideas of self-regard. I think people who take risks of personal harm to benefit others (firefighters, say) are well-regarded by society, and while some are probably working through some sort of doubt about self-worth, I think a lot are confident enough in the rightness of their values that they don't mind taking a risk of dying for them. Self-sacrifice can be over-emphasized (and again, I think you may be over-emphasizing how much self-sacrifice is involved in a kidney donation), but I think I'd rather live in a culture that views Lawrence Oates as noble than one that views him as neurotic.

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Who are these many rationalists saying they deserve to eat suffering-infused meat? I'm not sure I've ever encountered that, the three common positions I see are "vegan" "not vegan but I should be and I feel very bad about it" and "animals have no moral value lmao".

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I haven't encountered that either. Other positions I have seen are calculations that include more than "do animals have moral value," such as how much human suffering is involved in meet processing vs dairy production vs various agricultural labor, or environmental impact. Even setting aside health and culture, veganism isn't a clear cut moral question

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Raises hand. I think that animals have moral value and should be treated with respect and kindness until the moment that we kill them humanely in a way that they are genuinely surprised by and not frightened by until the very last possible moment. I would like to set that as the goal, rather than having no animals used in agriculture.

... because I just like eating animal products. I'm not going to stop. I see humans as having orders of magnitude more conscious experience (one or three? who knows?!), but that animals clearly have an experience of the world.

I feel like a choice has been made by vegans that we EITHER have no animals raised for agriculture or we have murder suffer houses from hell. It doesn't seem hard to me to propose technical solutions (instant brain death, humanely-designed places where animals are relieved of their lives) which don't break the laws of physics, so are therefore possible.

This is like people saying that carbon capture/climate mitigation is literally impossible so we all need to reduce our per-capita energy expenditure to 100kW and that's the only thing they'll hear about it. Good luck getting people to use 100kW/year, good luck getting people to stop eating butter.

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Getting ingredients for butter (milking cows) actually improves the quality of life for the cows. If not milked, they get pain. This is what puzzles me about vegans avoiding any animal products at all

Which reminds me of this exchange I read about a customer's interaction with a retail store clerk:

Me: Do you have any wool sweaters?

Clerk: No, we don't believe in killing sheep just to get the wool.

Me: Neither does anyone else!

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> If not milked, they get pain.

That's because we have bred them that way. I assume the wild cows do not have this problem.

The next step is to genetically engineer slaves who will feel pain when they have no master. Then it will be ethical to keep them, and we can laugh at the silly abolitionists.

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"Bred them that way" is too strong. In the wild, calves would stop taking milk from their mothers, so they would likely dry up. Domesticated cows continue to give milk because we keep milking them. Stopping suddenly would give them pain, like you having pain from a full bladder.

In what way is it cruel to milk cows? To shear sheep? To harvest extra chicken eggs? Cruelty is abhorrent, but if one is not party to it, then one is not guilty of it.

Factory farming can be cruel, and I can understand people sensitive to such things avoiding it and wanting to stop it. I cannot understand opposition to a responsible farm.

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> I cannot understand opposition to a responsible farm.

99% of people who say this are still getting their food from factory farms.

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Depending on your system, dairy farming can be much better on carbon efficiency:

https://www.farmersjournal.ie/more/climate-and-environment/new-zealand-dairy-farming-almost-40-more-carbon-efficient-than-in-ireland-598831

Irish (and New Zealand) dairy farming relies on grass grazing and pasture-fed animals rather than indoor feed lots. Continental Europe has moved away from grass and there is interest, particularly in Germany, in developing grazing.

https://www.teagasc.ie/media/website/publications/2022/Dairy---Grass-into-milk-in-Germany.pdf

https://www.farmersjournal.ie/news/news/germany-goes-grass-fed-for-milk-782212

There's even been a study about German dairy farmers personalities and effects on animal welfare:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277219

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The relevant issues are economic. Raising animals in a truly healthy way is extremely expensive. It is time and labor intensive. We would have a lot less meat and it would be a lot more expensive if all food animals were raised free-range.

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I don't know why you'd expect self-proclaimed rationalists to have consistent moral beliefs and act on them. They're still human, after all. Ultimately, the only way to perfectly follow your moral principles is to not have any in the first place. ...Not that I'm suggesting that's a good thing.

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Agreed. I think this is an extremely important point.

Relatedly, I think that any moral framework that requires extraordinary actions from ordinary humans is fatally flawed. If you live in a meat-eating culture, that means you grew up with the habit, it means you're constantly exposed to temptation, and so on. I can't support any moral framework that *requires* you to spontaneously realize that eating meat is immoral, and to take the huge social cost of being an outsider upon you. It's society's fault that you eat meat as much as your own.

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>Otherwise, I find it interesting that so many people feel protective of potential kidney donors and want to protect them from self-sacrifice. This isn’t selfish (they’re trying to protect someone else). It’s not exactly altruistic (it’s preventing an act of altruism which I think everyone agrees is probably net positive). So what’s the psychological motive here? This isn’t mysterious at all to me intuitively (I can imagine doing the same thing in some circumstances) but it sure is hard for me to explicitly model.

My best guess is that this is essentially a flavor of tribalism.

Even if you don't have a specific argument in mind for why some particular behavior is likely to be harmful, you're liable to feel wary, and want to push back, if you have the impression that it's characteristic of a weird and alien viewpoint which is likely to clash with your own in significant ways.

If you're a person who (for example,) has an overall negative view of the religion of Islam, and believe it promotes dangerous and regressive social behaviors, and you see a Muslim participating in daily prayers, you'd likely feel anxious, not because you'd have some specific reason in mind for why participating in daily prayers is harmful, but because it activates your "Oh, this is a thing from that cultural group I distrust" thought patterns. Those feelings might be grounded in more specific fears of things you might clash over culturally, but those fears don't need to have any specific reference to the daily prayers, that's just something that functions as a cultural identifier.

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"I donated my kidney, but I’m probably not going to donate a lobe of my liver (even though this is also mostly safe and also helps people in need). This isn’t because there’s a real distinction about which parts of my body are vs. aren’t sacred, it’s just that I guess I’m ethical enough to do something moderately hard and painful, but not to do something very hard and painful."

Scott, have you spoken to anyone who's donated part of their liver? I have. It's not "very hard."

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You might be bolstering Michael Watts's point with this.

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Sorry I don’t see how so?

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You're trying to convince Scott to hack off even more pieces of himself (for the greater good, of course). And if the numbers are right, you might actually succeed. This gives off PRECISELY the same vibes a cultic ritual self-mutilation.

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Nov 7, 2023·edited Nov 7, 2023

You're begging the question here. Obviously if you are already inclined to agree with Michael Watt, you will see this as further evidence that EA is an abominable castration cult. But if not, it's just someone offering (what they claim as) a fact that conflicts with something Scott said in the post, and which might be decision-relevant for him or others.

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I can see why you'd say that; that is indeed the most plausible explanation. The thing is I WASN'T inclined to agree with him before I saw this, and this is what convinced me. I now hold that the "Schelling fence" of keeping all your organs, and only giving them to friends and family as needed, is worth keeping.

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Nov 7, 2023·edited Nov 7, 2023

Fair enough. I think you must have been pretty close to the line, though, if a single pseudonymous comment was enough to push you over it. (At full Wattage, too: 'hack off even more pieces of himself'; 'cultic ritual self-mutilation'.)

Heshy is one person, if they're wrong on the facts there will be pushback (including from people who are sympathetic to EA and to altruistic organ donation), and in any case the EA community as a whole will definitely allow Scott to stop at kidney donation and be celebrated for it, rather than shamed for not going further.

If liver donation has a good altruistic reward : personal risk ratio, EAs will tend to praise it and some will actively encourage it. But I don't see how that could come as a surprise -- that kind of thinking is basically their whole thing, and they're not secretive about it.

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It's always fun to spot The Worst Argument In The World in the wild.

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Is there a central example of "cultic ritual self-mutilation" from which this substantially differs?

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Self-flagellation is supposed to benefit the flagellant, not anyone else, whereas liver donation is supposed to benefit someone else, so that seems like a substantial difference.

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How? I don't see it.

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Honestly I wasn’t trying to convince Scott to do anything with his organs. I was more concerned that others, who are already inclined to donate part of their liver (which grows back), might not do so due to Scott’s misinformation in this piece.

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My understanding is that the risk to the donor is at least an order of magnitude higher for liver donations than kidney donations. Is that wrong?

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My understanding is that it used to be correct, but now it’s wrong. But I’m not a doctor.

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FWIW Manifold puts a 50% chance on LDNT being false, though not for any specific threshold.

https://manifold.markets/IsaacKing/is-the-radiation-hormesis-hypothesi

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That's quite impressive given that the question is specifically whether low level radiation benefits exist. If that has a 50% chance of being true imagine how high the specific bet might be on LNT being largely inaccurate

Jack Devanney proposes SNT, sigmoid no threshold, where the risk transitions rapidly somewhere in the 30 mSv range. Most of the LNT debate is about nuclear meltdown levels of exposure like .4 mSv max for civilians in Three Mile Island

https://jackdevanney.substack.com/p/a-sigmoid-no-threshold-primer?utm_source=%2Fsearch%2Fsnt&utm_medium=reader2

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A bit disappointing how many rationalists don't think any deeper than "that's like weird so ewwww." It's like fifth grade all over again.

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author

Half wish there was a bot that replied this every time someone claims the ACX comments section or the SSC subreddit is full of rationalists.

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One additional point I think is worthwhile for Scott's particular donation:

My guess is that Scott will at minimum influence 50-100 future kidney donations with his posts and kidney advocacy. Potentially much more. I am dead-certain that Dylan Matthews, as an example, has led to *hundreds* at minimum and potentially thousands of donations on the high end as a result of his articles and advocacy. And I think Scott is roughly on par, influencer-wise, with Dylan.

So his decision isn't really just "Is my donation worth it". It's particularly impactful for him (and any other person with a huge platform) to donate, because of the multiplier effect they cause.

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