>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!
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.)
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.
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.
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.
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.
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.
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)?
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.
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?
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 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).
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.
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
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.
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:
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."
>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."
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.
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.
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.
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.
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.
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.
'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.
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."
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".
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.
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.
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...
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.
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.
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;)
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)
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.
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...
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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?
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!
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.
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.
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
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.
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.
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.
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).
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.
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).
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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
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).
- 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.
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).
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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!
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?
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.
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".
"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"
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.
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.
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.
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.
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
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.
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.
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.
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
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.
> "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.
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.
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.
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.
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.)
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.
>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!
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.
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.
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.
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.
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.
>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.
> 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.
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.
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."
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.
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".
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
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.
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.
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.
"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.
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.
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.
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.
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.
>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.
"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."
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.
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.
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.
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.
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.
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.
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
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.
So, if I disagree with the moralization framework should I be more annoyed that this is going to influence a bunch of people to do a thing? (I don't actually care, and I think the world would be slightly better if a bunch of people donated kidneys).
But... I disagree with Memeplex Virus Spreaders spreading their meme viruses too aggressively. I want to reduce the spread of bad meme viruses (idpol/anti-idpol craziness) and I'm okay if that makes it harder to spread good meme viruses.
The first propagators of a meme virus are probably doing a good job/know what they're talking about/have a good idea. But eventually every memeplex will devolve in to vegans who look doughy and greasy because they only eat Oreos and complain about people eating honey.
I don't have a super quippy version, but perhaps it is a young person who never really did anything with their life and reads a couple of un-challenged blog posts about how easy it is to donate a kidney, so they sign up and go through with it. A bunch of years later they decide to get really fit and start training really hard and it turns out that maybe 85% kidney capacity just ain't good enough, and also the recipient ended up dying or rejecting their kidney and they didn't sign up for this shit. It's easy to opt in to reduced bodily health capacities when you're young and your life meter is at 100% but I've been really surprised how things start to degrade for me and my friends as we hit 40.
I love when normal, average dudes sign up for the most memeplexy versions of Twitter MeToo Feminism and then get bit by that one bad date they had and get tossed from their social circle. I imagine a bunch of living donors being similarly enthusiastic about the memes they were fed until it turns out that maybe they really should have kept that organ that they evolved to have two of because they weren't the invincible super humans they thought they were in their 20s when EA was a fad.
I'll take another shot at this after scrolling down 10cm to see more replies in this sub-thread. 10cm below your comment, people discussing how influential Scott vs Dylan (someone I haven't heard of) are and how one guy convinced 8 people to donate their kidneys through podcasts.
Now I'm picturing a bunch of in-group status jockeying between vanlife fitness influencers who think they're invincible because flavoured protein water brands pay their bills. The best way to out-signal someone is to donate your kidney and periodically lobes of your liver.
I used to follow a few vanlife people and for some reason, they always end up killing themselves, quitting the vanlife in disgust/exhaustion, or accidentally run over their dog because they want to get the perfect shot. How likely is it that influencers have it all figured out? Pretty low, just like the rest of us, just like kidney/liver donation influencers.
Aren't there only like 200 stranger donors a year, per Scott's essay? Even if Matthews accounted for *every single one*, which seems absurd, he would barely be responsible for a thousand. If you're suggesting he influenced more family and chain donation, though, my estimate is moot.
I would suspect Scott is more influential than Dylan, though. Dylan might have a larger readership, but a low-quality one (that's partially anti-Vox snark, but a more general statement regarding the casual nature of "news" readership); Scott's is more dedicated and prone to being influenced by him.
My estimate is informed by my own story. I am one of Dylan's downstream donors who was influenced by him. And I, by myself, have influenced at minimum 8-10 people to donate through podcasts, AMAs, and other channels. I look at my own success convincing people and think that Dylan must have been much bigger.
"You don’t kill your cattle on the full moon while chanting unless you’ve heard of other people doing that, but it might occur to someone to try to figure out how to do the most good even if they haven’t been brainwashed into trying. I’m more surprised that so few people find it to be an intuitively obvious goal."
I'm sorry. I may be missing something, but I just don't understand how Scott can keep describing Effective Altruism like this ("do the most good"), and how so few comments seem to really challenge this head-on, when Scott (along with this community) was the one who popularised the most lucid description of this exact fallacy: the motte-and-bailey.
Doing the most good means, in practice, saying hypothetical future uploaded "people" are as important as real people, with people lives and real suffering, who actually exist right now. It means actively supporting the destruction of "unwanted" human life on an unimaginable scale to slightly benefit the majority. Or less horrifically, it means getting the best outcomes *at the expense of every other moral value*: e.g. embracing the widely-recognised vice of greed in "earning to give".
HOW is calling these things "doing the most good" ANY different from calling feminist positions (eliminating due process, cryshing freedom of speech) "believing that women are people"? That was the context Scott originally introduced the concept of motte-bailey, and yet it never gets applied to EA. The only possible defence I can imagine is that the above EA positions are not very common. Is this the case? And if not, am I missing some reason this whole ideology isn't as dishonest and cult-like as every other one?
Hmm it sounds like you have a biased/warped view of EA, are you perhaps confusing it with the LessWrong community (which is much more focused on AI)? The strongest associations I have for EA are using 10% of one's income to buy mosquito nets in Africa and eating fewer chickens.
Longtermism is something like 40% of EA spending, last I checked. Not sure how much the collapse of FTX affected that though.
I think longtermism gets something like 80% of EA *attention*, especially external like MacAskill's big book tour last year, while the bednets chug along quietly in the background, but that's not as easily measured. If you've been watching them a long time you still think "bednets," newcomers think "digital people of the far future."
OK, I haven't paid much attention to McAskill and longtermism. I admit I thought it was more about climate change and avoiding X-risks (also including AI, sure) than mind uploading.
I appreciate the question! I remember it was a nice little bar-chart, most likely on EA forum or The Zvi's substack... but I can't find it currently. Alas.
Your perception is probably correct, however it's quite funny imo because there was an EA meme around 2018 where it was said that recruiters lure in newcomers with global poverty and bednets, then you proverbially pull the rug out from under them because of all the x risk discussion afterwards convincing them towards Ai!
The way I see it, the foundation of EA is literally 'do the most good', and to advance a cause within EA you need to make arguments to that effect. But there are inevitably going to be serious disagreements at both the philosophical (what is 'good', how do we measure it) and empirical (what are the likely effects of our actions) levels. So two people can legitimately describe themselves as EAs while pursuing very different, even actively conflicting, goals -- or while pursuing the same basic goal in conflicting ways.
An intellectually serious EA, while they might hold that 'do the most good' -> 'take actions X Y Z', won't actually conflate the concept 'do the most good' with the concept 'take actions X Y Z'. So you'll be able to have a conversation with them about why they hold the specific positions they hold, what assumptions their most important decisions are based on, how they would behave differently if they were convinced of arguments A and B, how *you* should behave differently from them given disagreements G and H, and so on.
I've tried to answer this at https://www.astralcodexten.com/p/effective-altruism-as-a-tower-of . I do agree that the positions you call "the above positions" aren't very common in the movement (and I can't even figure out what you mean by "destruction of unwanted human life").
I also think "embracing the vice of greed" is a mixing up of levels, sort of like if there was someone with a metabolic condition that required them to eat more than usual and you accused them of "embracing the vice of gluttony". I think of all of these things as heuristics in the same sense as in the response to Stephen at the top of this post.
Ever since I saw that Tower of Assumptions post (which was some time after it was posted, so the comments were dead), I've struggled to see how it isn't a general counter-argument against every motte-and-bailey criticism. Surely you can apply it to feminism ("women have the same value as men" at the bottom and "rape accusations should be believed without question" higher up), to Christianity ("there is beauty and order in the universe" at the bottom and "homosexuality is wrong because God says so" higher up), and so on. Allowing this defence only to Effective Altruism is an Isolated Demand for Rigour, surely?
And if it *does* apply as a defence to all these other movements, well I have problems with the idea of a tower of assumptions that I can elaborate on but basically boil down to the same point you were making in Social Justice And Words Words Words. Otherwise, is the only difference for you the frequency with which the extreme positions occur? So if somewhat less (but still a decent number of) feminists/Christians/etc believed the objectionable thing, the motte-and-bailey objection wouldn't hold? How do you decide the proportion of a movement's members that must believe x before it's fair to ascribe x to the movement as a whole?
" and I can't even figure out what you mean by "destruction of unwanted human life" "
Mostly, destruction of unborn life. By promoting abortion (not just as something that should be allowed, which is questionable enough, but that should be actively promoted and enabled). By promoting, especially, abortion and even infanticide of babies with some condition (e.g. Down's Syndrome) that doesn't make life not worth living but is inconvenient for society. By advocating polygenic selection without talking at all about whether it would lead to destruction of embryos, whether it would increase implantation failures, and so on. It may well be that there are morally satisfactory answers to these questions. What I object to is the fact that, in the discussions I have seen, the questions are basically not raised at all!
To your last paragraph, that seems a straightforwardly extreme-consequentialist response: not just that consequences matter, but that ALL other values ultimately reduce to consequences. Which is exactly my point, that EA claims to be about "all else being equal, do the thing with the best outcomes" when it's really about "do the thing with the best outcomes, all other considerations be damned". Honest consequentialism is fine; I don't agree with it, but I respect it. What I object to is a movement calling itself Effective Altruism instead of Consequentialist Altruism. The way they present themselves, and certainly the way most people are going to perceive them, is as much less than consequentialist ideologues, which (judging from things like "earning to give") they are.
EDIT: Just to elaborate on the basis for the "embracing the vice of greed" objection, it's this: if you participate in a system where you exploit people, gather wealth in dishonourable ways, are you more culpable for these things happening than you would be if someone else did those things instead of you? The consequentialist says no, it's the same result either way (people are exploited for money) but if you use that money for good you're actually making things better. The non-consequentialist says yes, the fact that *you* are doing the exploiting makes you personally culpable in a way you wouldn't be if you refused to take that job and someone else took it and did the exact same thing. This is more clearly expressed in Bernard Williams' thought experiment "George the Chemist", and it seems very widely intuitive and requiring substantial argument to refute.
If culpability in dishonorable wealth-accumulation is something to avoid, isn't it also undesirable to foreseeably condemn someone else to that fate? Perhaps not to exactly the same extent, but given that you apparently believe some responsibility for other peoples' moral decisions exists, sufficient to motivate an attempt to talk EAists into making better moral decisions, the remaining question is only a matter of degree.
>how so few comments seem to really challenge this head-on
Many commenters have probably learned that EA is one of those topics you can't really critique to Scott, except on very narrow grounds and/or if you've proved your greater sainthood already. Taking the big critique like that is generally a waste of time.
> I am proud to be an American, where I have freedom of speech, freedom to take melatonin whenever I want, and freedom to donate a kidney. You’ve got to keep exercising rights if you want to keep them, and I’m proud my country has defeated the evil bioethicists on this one and kept this option open for me. (The UK, Canada, Australia, and I think most other European countries also allow altruistic donation; Germany is a rare holdout here. Still, the US was one of the first, and I’m still proud of it.)
I don't think we can really claim to have defeated the evil bioethicists here; selling kidneys is still illegal. (May also be due to the evil pro-poverty lobby.)
"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?"
It's selfish. People don't want to donate a kidney because that's a lot of work, so it's in their self-interest to avoid the normalization of kidney donation, lest they find themselves in a world where every annoying charity worker is badgering them for internal organs.
It's one thing to acknowledge that kidney donation is "a commendable act of a saint" and then keep not doing it, because of course you are not a saint, you are just a regular person. But when kidney donation is just a regular thing you can do, moreover, a rational thing to do, if you value the lives of other humans, now you immediately feel social pressure.
When "a lot of work" means taking a month off work, potentially flying across the country and spending a week in a hospital, adding some statistically-small-but-meaningful risk of chronic pain and death to your life, potentially having to eat a kidney-safe diet, etc, "selfish" doesn't look as bad as tends to colloquially.
Refusing on their own account I agree with you, but once they start trying to persuade other people not to just so it's a little easier for them to refuse it starts to look a little worse.
> I’m going to do the jerk thing here and accuse Stephen of being wrong about his own internal processes.
No, Scott, you're not being a jerk. You're a very nice guy. But you're also wrong here.
> How did Stephen come to value bodily integrity... “Value bodily integrity” is a useful heuristic for avoiding bad things.
"Value bodily integrity" isn't a heuristic for me for avoiding other bad things. Rather, bodily integrity is itself a good, among others. In computer science jargon, you might say it's a "primitive."
> I predict he would also consider vaccination, pacemaker-implantation, and contact lenses to be valid exceptions.
No, I wouldn't consider these exceptions at all (although I approve of all of them). That's because they simply don't violate bodily integrity in the relevant sense, as does removing an organ. Rather, they improve health or function in other ways (i.e., without violating bodily integrity).
> How come I, an outsider without access to his moral reasoning, can predict what exceptions he’ll allow?
As noted, you can't. (While you correctly predicted that I would approve of those things, you mistakenly took them to be exceptions to avoidance of violating bodily integrity.)
> Probably because he allows as an exception anywhere benefits > costs.
No, I would allow exceptions where I'm aiming to serve a greater good, such as "restore my bodily function when there is no better way." I know this may sound like the same thing to you, but it's not, and the attempt to recast it into cost/benefit terms will actually change it into something different (that produces different answers to some questions). Key point: I consider the goods in question to be nonfungible, not fungible utility.
> I propose he’s using it as a heuristic for what he really wants, which is something like trying to stay healthy and safe while balancing that out with satisfying his other values.
• Again, not a heuristic at all.
• Health is certainly a related though distinct good.
• Again, vaccines simply don't violate bodily integrity, so not even an exception.
> kidney donation still emotionally feels really scary and not beneficial to Stephen, he prefers not to do it, he can’t come up with a great utilitarian case for not doing it, so he falls back on a semi-crystallized heuristic
I don't find kidney donation emotionally really scary. I'm actually pretty adventuresome in terms of medical interventions (just not those that violate bodily integrity lol). I don't even look for utilitarian cases for or against things, because I don't think that's what makes them good or bad. I don't much rely on heuristics for this sort of thing.
There is a factor of magnitude that comes into play when judging whether to endure harm to one good in pursuit of another. In both the case of a paper cut and a vaccine, the skin breakage and damage to blood vessels are minute. Unlike a paper cut, vaccine serves another good (improvement to the immune system). I said that a vaccine isn't even an exception to "avoid harm to bodily integrity." If one wants to be pedantic, I suppose one could instead say that it is a trivial exception, warranted by the good served.
I don't analyze it as an exception. I analyze as an trade-off of the harm to bodily integrity for the sake of the good of health. In this particular case, the trade-off is easy because the harm to bodily integrity in trivial, and the increase in health is therefore more significant.
I don't analyze this in terms of cost-benefit, because that implies a common, fungible dimension of utility in which costs and benefits could be measured and weighed.
So I think that's the same as what Scott predicted: you do see it as a (very minor) violation of BI, but one that you consider worthwhile because the good outweighs the harm. Like most people, who don't have a "bodily integrity" axiom.
What’s the difference between a trade-off and a cost-benefit analysis?
It makes sense that you’re willing to accept small harms to BI for great benefits, and if the benefit was great enough I assume you would accept even great harms to BI (e.g., removing a cancerous or gangrenous appendage to save your life). Scott also is willing to accept harm to BI (the kidney) to save a life, but the life is someone else’s. Why is that a fundamentally different calculation?
The difference is between fungible utility and nonfungible goods.
Very loose analogy: Imagine you are a collector of Nonfungible Tokens representing trading cards for a game. The rules of this game state that the NFTs cannot be bought or sold, only traded. You might have a discussion with a fellow collector and decide to trade your card A for his card B. This could be for any number of complicated, possibly difficult-to-express reasons (say, regarding how A and B functionally relate to the others cards in your collection). But the reason is not because A has a market value of $3 and B has a market value of $5, anything else reducible to something similar.
I claim that this is meaningfully different from buying or selling things in dollars, bitcoin, or any other fungible token, or trading things chiefly on the basis of such.
...Honestly, at this point I'm just confused what you even mean by "bodily integrity." If you don't want to donate a kidney because you don't want to risk making yourself less healthy, you can just say that. We're not going to judge.
Reading through everything again, I think this is all just a misunderstanding. When people hear "bodily integrity," they assume you're talking about some body purity thing (refusing to modify your body in any way with treatments, prosthetics, etc), but it seems that you just don't want to do anything that would hurt your body, which is perfectly fine. I still don't understand what that has to do with morality though, especially when you say that restoring bodily function serves a "greater good," when the entire situation only involves you. When people talk about morality, it's generally about how you interact with others and how your actions affect them.
> I still don't understand what that has to do with morality though
For me, it's just the opposite. I recognize no sense of "morality" whatsoever apart from promoting particular goods and avoiding harm to particular goods.
Regarding the "how is this not like a cult getting people's money" comment, I saw people point out that the kidney is not going to the cult, but to strangers. But I didn't see anyone point out that religious movements that persuade people to devote a lot of their money and time *to good-faith charitable causes* (i.e. benefiting strangers, not the religious leaders) rather than to self-serving cult leaders aren't vilified; they're generally praised. So it seems like the commenter's argument is "if we don't like it when people are persuaded to do harmful things, why should we like it when they're persuaded to do good things?"
(Also a lot of people will straight-up openly assert this. I don't know how they explain why they themselves engage in trade when they are apparently losing from it.)
Even if trade is mutually beneficial, the "surplus benefit", or whatever the technical term, can be arbitrarily distributed between the traders. If you believe that any distribution other than equal means screwing somebody over, then the vast majority of transactions do just that, due to various power, information etc. differentials.
The crucial mistake here, of the "perfect is the enemy of good" variety, is imagining it's easy to change the distribution without losing value in the process.
Yes, sorry, I got a bit sloppy there. A lot goes into the interpretation of "screwing someone over". A liberal would interpret it as "making someone worse off", whereas a leftist would interpret it differently.
That said, there are a number of people who will straight-up assert zero-sum-ness, which is much less ambiguous and almost certainly incompatible with their own actions.
It's not just random people that have this viewpoint, even illustrious philosophers fall for this 'Naïve Cynicism' and conclude that "Things shouldn't be allowed unless no one actually benefits from it -- since if you're benefiting from it, you must be screwing someone else over." See https://www.econlib.org/library/Columns/y2020/Muellerjustprice.html & https://www.metmuseum.org/toah/hd/schg/hd_schg.htm for example -- it's Aristotle on "Just Prices", Aquinas condemning "profiteering", Confucian philosophers deriding merchants as leeches and parasites below even, *gasp*, the artisans...
(Though I suppose some would argue that illustrious philosophers are *especially* prone to believing that merchants must secretly be leeches, whether out of jealousy or sheer confusion over how uneducated dolts can show them up and accrue more power and influence than any would-be philosopher king... the easiest way to explain it all away is that it must all secretly be a scam.)
An anecdote in favor of transplant evaluation people: I was recently a stem cell donor for my dad's cancer treatment. I had to talk to a social worker, whose job was to tick a bunch of boxes saying I was sane enough to consent to the procedure, and wasn't being coerced.
She was as upfront as she could possibly be, short of grossly breaching professional norms like, that her job was basically to make sure I wasn't part of the tiny minority of people who are actually being blackmailed into donating by their families, and that aside from that our conversation was basically useless. When she asked me "can you tell me in your own words why you're donating" and I looked at her like she was an idiot and said "because I don't want my dad to die of cancer" she chuckled and gave me a "yeah I get that a lot" smirk. She also gave me some off-label advice on how to avoid feeling like crap after the donations ("the doctors will just tell you to hydrate, but those electrolyte sports drinks are really where it's at, chug a bunch of Gatorade the day before and right after the procedure and you won't even notice the side effects"). I can't say whether her advice was actually good, but I followed it and I felt fine.
None of this means you shouldn't lie to these people, because the consequences of telling the truth if you happen to get an evil one are terrible. But there is at least one of them who is a sane human being.
"Multiple embryos are created and preimplantation genetic diagnosis is used to detect and select ones that are free of a genetic disorder and that are also a HLA match for an existing sibling who requires a transplant. Upon birth, umbilical cord blood is taken and used for hematopoietic stem cell transplantation."
In fact, the definition is a *little* broader than that:
"“We had to wait for the baby to grow. She had to weigh 10 kg before we could draw bone marrow,” Deepa Trivedi, program director of Sankalp Bone Marrow Unit in Ahmedabad, told The Hindu. It’s been approximately seven months since the transplant, and the older sibling has not needed any more blood transfusions, indicating he has been cured of his thalassemia, his doctors announced."
If the baby needed to be a minimum of 10kg, for a female infant that is around 17 months old:
Suppose, though, the older child needs some other kind of donation as they get older? How resistant can the younger child be to familial pressure about "do you want your sibling to die?" Apparently in the UK, you can't create 'saviour siblings' if the intent is for whole organ transplant, and a donor has to be a minimum of 16 years of age. But it is feasible that a sixteen year old can come under pressure to be the 'saviour' once again, even if they don't want to do so.
Donating bone marrow (stem cells, specifically) is an extremely low risk procedure. Your bone marrow is a renewable resource. As long as you want and take care of the kid, how is that evil?
You tell me how an 18 month old infant can meaningfully consent to a surgical procedure. I know parents make medical decisions for their kids all the time, but if a grown adult is going "No, I don't like the risks of bone marrow donation" why expect that a child who may be just about saying their first words can agree? We're not simply talking about stem cells, but actual marrow of the bones:
"Bone marrow donation is one of two methods of collecting blood forming cells for bone marrow transplants. Bone marrow donation is a surgical procedure that takes place in a hospital operating room. Doctors use needles to withdraw liquid marrow (where the body’s blood-forming cells are made) from both sides of the back of your pelvic bone. You will be given anesthesia and feel no pain during the donation. After donation, your liquid marrow is transported to the patient’s location for transplant."
The risks may be low, but it's a surgical procedure which always involves some risks, and for a very young child such as this, I think the risk from general anaethesia is likely to be higher.
And I think this little nugget demonstrates the kind of 'nudging' that the Evil Social Workers with their Checklists are trying to prevent:
"Not donating also has risks. For example, a sibling in need of an organ might be unlikely to receive a transplant otherwise. A child’s refusal to donate might, therefore, reasonably mean imminent death of the sibling in need. Besides being a source of guilt and remorse, refusing to be a living donor for a sibling in need could undermine stability and support provided by parents."
Again, even for an adult - plying emotional blackmail like "but your family member will likely die and then you'll be wracked with guilt and remorse, and your surviving family members may not love you anymore" is heady stuff, now turn that up to eleven for a child who is old enough to have some understanding of what is going on, but not old enough to be able to stand up to that kind of pressure. "Mom and Dad will hate me if I don't do this" is not a good enough reason.
(edited because I pressed post accidentally before I was finished typing)
I am a young adult blood and marrow cancer survivor. Taking actual bone marrow is indeed a very painful process. I have had several bone marrow biopsies where a surgical drill was used to collect a core sample from my bones while I was still awake. It is not pleasant, it is painful and distressing enough to be traumatic and I would not wish it on anyone.
But! Even though we still call bone marrow transplants such, they're mostly conducted with just stem cells nowadays. Most modern donors only have to take an injectable drug called colony growth stimulating factor for a few days, which stimulates their body to make extra stem cells of the kind that turn into your various blood cells, since blood cells don't reproduce on their own and instead your blood supply relies on your bone marrow continually pumping out new precursor cells. After that your blood is ran through a filter that's sorta like a one time dialysis thing, except it's collecting excess stem cells instead of toxins. This requires an IV which can be irritating. It's not a surgical procedure and it's outpatient. I have been on colony growth stimulating factor a dozen times, in a minority of people it causes pretty bad bone pain for a few days but it is relieved by taking Claritin, for some reason nobody is sure about. Very few other notable side effects that I can remember. Also sometimes the nurses forget to warm it up before injecting it and the injection site hurts momentarily, as is typical when you have cold fluid injected into your muscle.
Does it change my mind? On the risks, yes. On whether very young children should, in effect, be used as spare parts generators - no. I realise that there are safeguards in place around that, and I'm glad, but I still think even taking stem cells from 18 month olds is dubious. It's to save a dying sibling, and the infant probably won't remember much if anything about the procedure, but it's still a very big decision to make on behalf of someone to whom you owe a duty of care.
I admit, I'm not able to generate a universal rule out of what is unease on my part, it's just my own personal view of the matter.
"And Stephen admits there are “a thousand and one exceptions”. Later in the thread, he lists some of these: blood donations, haircuts, laser eye surgery. I predict he would also consider vaccination, pacemaker-implantation, and contact lenses to be valid exceptions."
I don't think it's that hard to square the circle on "exceptions" to the notion of bodily integrity. The examples given would violate bodily integrity only if you define that in terms of the structural composition of the body (i.e. keeping the body as it is, without additions or removals), perhaps out a sense of purity or a belief in the sanctity of the form. But if instead you view bodily integrity as conditional on the functioning of the body, then the exceptions stop being exceptions and become legitimate extensions of the idea. Blood donations, vaccinations, haircuts, pacemakers, and so on are fine because they either improve bodily functioning or don't negatively impact it in any permanent manner. Donating an organ, in contrast, does.
Good point, actually ”bodily integrity” was just a red herring, leading to unnecessary discussion, and what he is against is damaging bodily function. Although that still leaves the question of stuff like vasectomies.
Is blood really so categorically different? They are functional cells of your body. You will have lower haemoglobin levels and must be at least somewhat at more risk of serious blood loss or other complications in the case of an injury in the next few weeks after donation.
The main difference morally seems to be that the risk from blood donation's impact is (as far as we know) temporary, but I'm not convinced that's a tidy distinction to base a moral principle on. It seems like a pretty smooth slide in terms of from hair donation to plasma donation, whole blood donation, bone marrow donation, liver donation, kidney donation.
I don't see how it's a smooth slide at all. Your blood, at least when taken in the context of a blood donation, is easily and quickly replaced. Your kidney never will be. Removing the latter affects the integrated functioning of the body in a categorically different way than the former. If you value bodily integrity (in the way defined above) then the two are not comparable. If kidneys grew back then this would be a different discussion.
If you're arguing against a smooth slide existing, shouldn't you be picking two things that are adjacent to each other on that slide, and explaining how there is a discontinuity there?
To stretch the metaphor, all you are saying is that there is a categorical difference between being on top of a slide and down a slide.
To make this a bit more concrete: you say "If kidneys grew back then this would be a different discussion". Well, livers grow back, though it appears that it can take years to regrow to the pre-operative size and we lack the data to know if this always occurs. So where does that sit?
Thanks for highlighting my comment. My last name is Böttger not Bottger, with an o Umlaut. Not that it really matters, since you wrote it correctly in the Book Review Contest 2023 Winners post.
> I find it interesting that so many people feel protective of potential kidney donors and want to protect them from self-sacrifice.
My guess on the underlying instincts: the person you're talking to matters more than someone who will never know you existed. So you want to talk like you're protecting their interests. And the people being talked to were potential donors; potential recipients weren't on the radar.
I know this doesn't bring much to the discussion, but the phrase "Opt-Out Organ Donation" just makes me feel such an instinctive fear like I've never felt about any other string of words. I imagine that I've spent way too much time around the privacy protection and free software side of the internet where the words "opt-out" 99% of the time have a very bad to Orwellian bad connotation (as in "oops, you forgot to opt-out of Google Maps tracking your precise location 24/7 and selling it to advertisers/law enforcement/anybody else" bad), but still.
In many transactions, each party has separate representatives. (Buying a house for example: the buyer and seller each have an agent, and it's a bad idea for these to be the same person.) It seems like some of the challenges with those who participate in transplant evaluation are because their responsibility is to the hospital, not the donor. Your representative could help you understand the process, the kind of questions you'll be asked and how best to answer truthfully, and redirect to a different hospital if needed.
Separately, I wonder about a survey that asks whether you'd be willing to donate a kidney and, upon receiving an affirmative answer, pivots to "great, let's get you scheduled".
Perhaps these could even be combined: those who express interest in donating are assigned a donor advocate who acts in the prospective donor's best interest, helping them to reflect on and make an informed decision, and then guides them through the rest of the process.
"I resent being treated as the dupe of an ideology that I helped form."
And I resented your initial blog post on this topic, but I didn't say anything at the time. Now I'll say something I suppose.
You've been duped by an ideology that you helped form. This ideology doesn't even sound correct or good to most normal people (your simplistic notion that it's just trying to do the most good is as ridiculous as a Communist trying to say that Communism is just wanting equality for everyone), and it has done extensive damage to the world as it stands. Oh, but somewhere some people were nice to you or something, so who could have predicted that FTX was a scam? I would have said it was probably a scam, because I think EA is an obvious hotbed for scams. Everybody who dislikes EA's would have probably said it. But you've donated a kidney and others have too, so all's well that ends well. You can calculate this scientifically or mathematically or something, using methods that your cult finds convincing, as do high prestige morons.
Bodily integrity is not a heuristic. It's not a weird moral rule, some kind of basic assumption for practical purposes. Not everything is a heuristic, heuristics are for decision making especially in mathematics and social science fields, they aren't identical to priors, or moral values, or sentiments, or traditions, or any of the other dozen alternatives that would lead somebody to dismiss your kidney argument out of hand. But if you think these are actually all synonyms, maybe use some of them for once.
More importantly, there is an alternative phrase for bodily integrity. Bodily sanctity. Far from being some weird moral rule, a strange exception or random thing, this is an explicitly stated position in the biggest religions in the world, religions that have been far more dominant in the past than now. Here's a heuristic for you, what is old is tried and tested, what is new is probably wrong, and your entire world view doesn't extend before the modern era. I don't want to hear about "exceptions" from people who can't identify what is and isn't a heuristic, and can't fathom why anybody would believe in bodily sanctity, or understand how it works for normal people (not all of this is targeted at Scott specifically). As much as I don't want to defend somebody when they didn't ask for it, when Stephen made his comment, I would say his comment was a heuristic only in the sense of being a blog comment, not as a moral position. Because Rationalists are so weird, and not in a good way, it would take a lot of time to explain extremely basic and widely held notions of the sanctity of the body, the difference between the essence of an object and its particular instance, what is and is not the "body" in the specific way under discussion, etc. So you fall back on simplistic version of the argument, accept that exceptions can be found under this simplistic version, and try to move on for the sake of discussion.
And I'm not even of the opinion that one shouldn't donate their kidney. Sure, do it, it can be altruistic. But it can also be a bad thing. Perhaps it can be bad when you make a blog post about it to a large number of people in an attempt to convince them to offer up their organs in the name of your cults and the false god QALY.
How is what you are saying isn't a universal argument against anything that has ever failed in any way? Why can't we use it to declare capitalism a scam after the first financial crisis? Or whole human civization a cult after the first war? And don't even get me started about religions.
Because the majority of "normal people" - a very conviniet category, by the way - are supporting them? So in all essence, it just ends up being boring concervative argument about status quo that you've rewritten in the least nice way towards Scott in particular? Or am I missing something?
I had a similar feeling from the article that I phrase like "there are all these people screaming at me to do X because that will make me good, and it's pretty obvious that they're really fucking wrong, so why is Scott any different?"
Also, nearly copy-pasting from my comment (sue me). Every memeplex (EA/idpol/religion) eventually gets more complexified and enthusiastic and thinks they are the solution to all problems. Communism did that. A bit of communism (thx Canadian healthcare), a bit of charity (maybe not EA, just like donate to your local food bank), a bit of hedonism (ska shows 4eva), a bit of capitalism.
I often think that the specialists are all wrong, and the most enlightened people are the mids who just keep acting like monkeys with slightly more advanced brains. The specialists are too focused on one thing that is THE BEST THING! We can benefit from their specialization if we don't listen too much.
Given sufficient time, all of them. It's not just EA, I think most charity organisations are probably scams. EA is only different because it is popular among certain high prestige groups who have money to both lose and desire. I will also note that at least part of this popularity is due to the general belief that charitable organisations end up as scams in the long run, and so EA can do better. Be more"effective" if you will.
Of course I understand your real point. It's easy to say after the fact that you knew X all along. I'm not claiming prophecy in this instance, merely cynicism on the effectiveness of EA and the motivations of those involved.
"I resent being treated as the dupe of an ideology that I helped form."
As a member of the "the group of people who kill your cattle on the full moon while chanting*" tribe, I had to smile at this one, since we're used to getting the "you are a dupe of the ideology" treatment from the rationalist/atheist/materialist/non-believer except in science side.
Welcome to the Religious Nutjob side, Scott, we have Death Cookies**!
I do think Scott did something admirable by donating his kidney, and I do think he is free to do so if he wishes, but that's because I'm one of the full-moon chanting cattle-killer types and we've been stuffed chock-full of tales of people who do self-sacrificial things 🤷♀️
*Well, technically weekly cannibal feasts of flesh and blood, hymns optional, but close enough right?
> but somewhere some people were nice to you or something, so who could have predicted that FTX was a scam? I would have said it was probably a scam, because I think EA is an obvious hotbed for scams. Everybody who dislikes EA's would have probably said it.
But it was a crypto scam. So the reason to think it's a scam is it's crypto.
If SBF had stolen all his clients' money to give to the AMF, then he would be based and cool (though a criminal and bad PR), and you could easily argue it would be an EA thing. But that's not what happened. He just punted all the money on stupid crypto bets. I have never seen someone discussing SBF in his own right go "he's bad because EA." At best you'll see "he was using charity to whitewash his own sins." Which doesn't require EA at all, and exists basically as long as wealth concentration has been ongoing.
I tend to support crypto. I also support the idea that crypto is basically 100% scams, and that predicting the FTX implosion was doable from the crypto angle just as it was from the EA angle. It was a crypto scam and all crypto is a scam the same way all of EA is a scam.
However, it isn't true is that SBF simply lost a bunch of money. He donated around 100 million dollars to various political organisations and candidates, which is where most of my practical ire of this particular situation comes from. It's one thing to give massive amounts of money to politics. It's quite another to steal it first, and then give it to politics.
I understand your point is that EA is not intrinsically bound to how this particular scam operated. Fair enough. He could have used any charity type thing to mask his crimes. I'll amend that I think basically all charities are scams, even if the concept of charity in itself is not a scam. EA is worse than charities generally, because it thinks itself better, more "effective", and does so on logic that I find obviously wrong and reprehensible. It is this logic specifically that is rife for abuse, beyond what normal manipulation would allow.
1. Most religions are not big on bodily sanctity, it even feels somehow heretic and idolatric as a concept. A weird flavor of New Age pseudo-Buddhism or nietzschean Vitalism that I doubt would sit well with most churchgoers
2. If you accuse a group to have done bad on the net, it's usually good form to bring receipts. And I say this as somebody pretty contemptuous of EA on an intellectual level, I can't really see how malaria nets are somehow out weighted by whatever your pet peeve is
3. "You believe to be doing good and be rational, just like the communists believed to do good and be rational, suspicious uh" sounds like a partisan and hamfisted parody of a conservative, wild seeing somebody saying it out loud
On the subject of what I said about religions, I didn't say "most" I said "the biggest." Beyond this lapse in reading comprehension, your claims here are not just wrong, but ridiculous beyond all parody. Let's very quickly go through the largest religions.
For Christianity, please read 1 Corinthians 6:19-20.
As a bonus for Judaism, please read Leviticus 19:28, in which bodily sanctity is considered to be avoiding idolatrous practices, which is literally the opposite of your nonsensical supposition.
Islam shares with Christianity and Judaism the basic idea that man was created in God's image, and indeed, At-Tin verse 4, says humans were created in the "best" form. It is Ijma, consensus, that Islam condemns mutilation of the body and even explicitly includes tattoos in that. Sahih al-Bukhari 5944, for example, is clear on the latter.
Hinduism is more varied, but even Dualist schools like Samkhya-Yoga understand that the body is sacred because it is the vessel of the divine Self. Ahimsa applies even to one's own body, and is also a tenet of Buddhism.
Now of all these religions, there are overriding principles to Bodily Sanctity that could be applied in organ donation. None of these religions forbid organ donation in principle. However, Scott's method of arguing the position is so horrendously anathema to all reason that I wouldn't see it as difficult to argue that Scott did something idolatrous/prideful. Admittedly only for the Abrahamics, I am not that learned in Indian religions.
As to your second point, FTX itself outweighs malaria nets if that is the kind of thing you're looking for from me. But if you agree with me that on an intellectual level EA is contemptuous, you might at least appreciate my position that the philosophical commitments EA makes are in themselves damaging to the world in the way that open avocation of Eugenics is commonly seen as damaging. I may not want to ban such apologetics, but that doesn't mean I must hold my tongue if I don't feel like it.
To your final point, you've completely missed my point. The analogy is not to compare if or how these groups have false beliefs, but rather, that the summation of their own position is clearly simplistic to the point of being basically lying. If Marx rose from the dead and tried to tell me that the summation of his thought was "equality of everyone", I'd call him a liar not because Marxism lead to Gulags or whatever, but because Scientific Materialism is so fundamental to the Marxist world view that making no mention of it is tantamount to propaganda. If it hurts your sensibilities to use Communism as an example, I would say the same thing about a Christian who said that the summation of Christianity was "Do unto others as you would have them do unto you."
I also value body integrity, but differently- not as a heuristic, it is something I actually feel strongly about. Even a thought of some internal part being taken away feels awful, even if it’s a part that doesn’t make a difference. I don’t really feel like the hair (except maybe for the follicles) is a part of it, I feel strongly interventions that don’t make the body in the long term different from what it was, I would suffer but agree to a removal of something that contains cancer. Vaccinations are fine, as they don’t take away or change anything. Piercing’s not fine, physically don’t like the idea. Donating a kidney to someone in need is not fine, even if it didn’t affect anything in the body, because I’d feel bad about missing it, not having it connected to the rest of me anymore, etc., so unless it is somehow really important (a close relative needs it), I wouldn’t do it, this is not a resource I’m happy to use to improve the lives of others
The fact that you have strong feelings about X, doesn't mean that it isn't a heuristic. Likewise, the fact that you have strong belief in laws of Newton, doesn't mean that they are not just an approximation of General Relativity, which itself is just an approximation of some deeper fundamental law of the universe.
Think about it in terms of objective morality. Your feelings are hints at what is moral but they are not necessarily unfailable - after all different people tend to have different feelings occasionally. So it seems plausible that they are approximations of some kind of real moral principle. One of such principles can be called "body integrity with caveats". It approximates feelings of some people quite well, though there seems to be a lot of disagreements about what exactly the caveats are supposed to be. And there are all kinds of other principles, so it really seems that there is some deeper moral law, explaining them all.
Sure, most of what humans feel like they value is related to heuristics that were useful in ancestral environments- or at least is acquired through heuristics for starting to value stuff which were useful in the ancestral environment.
It doesn’t have a feeling of morality to it- it’s not something that I consider universal. I feel bad for people who lose parts of them or even just do piercings, but I don’t feel like it’s immoral in any sense. I just feel like I’d be uncomfortable in their situation. People should be approximately* free to do whatever they want with their bodies, and I believe in this strongly, as a heuristic that has utilitarian justification. I don’t think the way I feel about integrity is in any way related to utilitarianism, though. It’s something I actually value, on its own, personally, not as a policy for achieving other means. Like, even if there are evolutionary reasons that make us enjoy ice cream, they don’t at all screen off liking ice cream.
(* I would like it to be hard-by-design for people to shoot themselves in the foot, but if they still go through the hardships to still do it, they should probably be able to)
Sure, but you value it *for yourself*, as a personal preference. I don't think you believe it to be a universal moral value which you would impose on others.
Right. Well, that's different from Stephen — I think (at least as interpreted by Scott) Stephen was trying to assert that it was a rule which he thinks should apply to others even when their expressed wish is to do otherwise. That's where the heuristic framing came in — "it only looks like a universalisable would-be moral rule because there's a reasonably universalisable *heuristic* that looks a lot like the supposed absolute rule". I don't think Scott has anything against idiosyncratic personal preferences.
(It's the same argument as heterosexuality vs. homophobia; nothing wrong with being personally grossed out at the prospect of gay sex, plenty wrong with trying to raise that into a universal rule.)
Oh, wow. I completely failed to parse what Stephen was saying as something about a universal rule and thought it’s about personal feelings acting as a heuristic.
(😅 I think this is possibly the first time in my life I’ve been compared to a homophobe, even if one who doesn’t insist on any rules)
I liked this post and I really enjoy reading here. However, the last but one paragraph kind of churned something inside me. It is offtopic but I think still worth mentioning.
> I am proud to be an American, where I have freedom of speech, freedom to take melatonin whenever I want, and freedom to donate a kidney. You’ve got to keep exercising rights if you want to keep them, and I’m proud my country has defeated the evil bioethicists on this one and kept this option open for me.
It is weird for me is to be proud of one's country because I think there is a lot to be ashamed of for (almost?) every country (for a reasonable person) and I cannot imagine the US are an exception. Can someone be proud and ashamed for the very same thing? I think it doesn't make sense, shame and pride are opposites. Am I correct?
Also, pride of the mentioned aspects of the US society, eg. freedom of speech, is questionable in my point of view. To me, pride is a rather personal feeling. I mean how much can someone be proud of something which they have not influenced, but were lucky enough to be born in the "right" place?
(Apart from this it is also weird for me to say "American" and when actually meaning "US-American" although it is common practice.)
There's nothing weird about being proud about some parts of something and ashamed of other parts. Everything is multifaceted; you don't have to categorize everything in black and white.
I don't understand nationalism either, but it's probably just a consequence of natural human tribalism. That's not necessarily a bad thing, since I doubt it would even be possible for huge, unified civilizations to form without some sort of instinctual unifying mechanism.
Everything has many faces, I agree. That's why I have a problem with Scott claiming to be proud of something as generic as the USA. Because pride means a kind of participation, it also means participation in the bad sides which undoubtedly exist. Or doesn't it?
Sure enough, "I am proud to be an American, where ..." can also be read as "I am happy to live in a place, where ..." But the word proud adds something to it which makes me uncomfortable.
I entirely agree with that. I was about to write a long text to develop why I agree with it, but then I noticed it would just be repeating what you just said, reformulated in a different manner.
I asked myself the same question. Being proud of something means to take some ownership in my point of view. This is, of course, a continuum. It can be very closely linked to one's own achievements, such as passing an exam, or more loosely linked to influencing a child through passing on DNA and upbringing. However, Scott's sentence (to me) leans more towards the end where it no longer makes sense, such as "I'm proud to be from California, where the sun shines every day".
This is true, but irrelevant, as no one said anything about a person from North America or any other continent or region. The term America is short for the United States of America - no other country has America in its name or calls itself America. Canadians or Venezualans don't call themselves Americans. That's just not what the word means. It means someone from the USA.
I'm a little confused by the Wytham Abbey point in the original article, and more confused by the follow up here.
The point (from Owen Cotton-Barratt's own words) was "The main case for the project was not a cost-saving one, but that if it was a success it could generate many more valuable workshops than would otherwise exist. Note that this is a much less expensive experiment than it may look on face value, since we retain the underlying asset of the building.
We wanted to be close to Oxford for easy access to the intellectual communities there. (Property prices weren’t falling off significantly with distance until travel time from Oxford and London had become significantly higher.) We looked at a lot of properties online, and visited the three properties we found for sale with 20+ bedrooms within about 50 minutes of Oxford. These were all “country houses”, which are commonly repurposed as event venues in England. The other two were cheaper (one ~£6M and one ~£9M at the end of a competitive process; compared to a purchase price for Wytham of a bit under £15M) but needed significantly more work before they were usable, which would have added large expense (running into the millions) and delay (likely years). (And renovation expense isn’t obviously recoverable if one sells — it depends on how much the buyers want the same things from the property as you do.)"
The original article seems (given Scott's participation and knowledge of the above quote (see reddit thread below)) calculated to drive rage engagement. Fine, sometimes it's good to get the blood moving. But then follow-up here also seems to forget we know why they bought the castle.
They set out looking for fancy venues right by Oxford. The fancy was part of the search, they want to own the EA conference version of the Institute for Advanced Study (a cool house in the woods. It was never "we need to save money on conference venues", it was "we need to save money on really cooooolll conference venues that are close to Oxford and inspire the soul". Fine, but setting this out as if it was somehow magically the cheapest way to do this (including converting a warehouse or cube farm office building) is baiting people into a (correct) gut-reaction of "that's bullshit".
tl;dr, the math probably works out if you include inspiring people near Oxford, but it was not a cost decision and retrofitting a warehouse was never on the table. People are riled up about this b/c it's presented (even in the EA-adjacent community) as "cost-effective to buy a castle as a convention center" when that's an intentionally inflammatory framing.
I kind of wonder if there were too many American nerds in the selection committee...we see castles and think "Tolkien and D&D", whereas Europeans (and Brits) have more of a charged history with the local nobility, rich toffs owning the land and all.
If I'm being ungrateful revolting peasant, it's not American nerds, it's too many upper-middle class, college-educated brats that never got their hands dirty snagging turnips and so imagine that fancy-schmancy venues to have Big Thinks in are the way to change the world for the better.
It's the same thing that annoyed me with Christopher Hitchens versus Mother Teresa. Say that all his criticism was actually true in every detail. What was the result? Her nuns were still taking people in off the street and giving them beds and food and some kind of rudimentary medical treatment, even if it was inadequate, antiquated, and ideologically driven. What did his criticism do? What did he do? What lepers did he physically pick up? None, because that kind of practical work is somebody else's responsibility. Now we, the educated chattering class, have dismissed the Bronze Age morality ideologue for being in the wrong, we have done all that is needed. The messy, unending, 'the poor you will have with you always' work to clean the sores and bind up the wounds? Too much manual labour, too low-status, for us to engage in.
Instead, let us generate valuable workshops where the questions are more important than the answers and results are not the reason we're here:
"Having an immersive environment which was more about exploring new ideas than showing off results was just very good for intellectual progress.
(F)or open-minded intellectual exploration I think it’s better to have the focus on questions than answers. I thought it would be great if we could facilitate more intellectual work of this type, and the specialist-venue model was a promising one to try."
'There was a rich man who was dressed in purple and fine linen and who feasted sumptuously every day. And at his gate lay a poor man named Lazarus, covered with sores, who longed to satisfy his hunger with what fell from the rich man's table; even the dogs would come and lick his sores.
And when the rich man would leave his house every day, when Lazarus begged for scraps or even a penny pittance from the wealth of the rich man, Dives answered that he could not do so, for he was busily engaged in asking what’s most important to do in the world with like-minded others who want to spend time thinking about ideas not event logistics. Arranging for food or money for the poor would only take time and resources away from such experts hosting events.
But not to worry, Dives reassured Lazarus, probably at some future time the open-minded intellectual exploration in an immersive environment would generate some solution to the problem of global poverty and disease, even if Lazarus had died in misery and pain long before then.
So saying, Dives went on his way to view the site of a very agreeable location that would be perfect for such events, if it were only large enough, historic enough, and luxurious enough to attract the kinds of people fit to associate with such rich and important individuals as himself. Meanwhile The poor man died and was carried away by the angels to be with Abraham. So it all worked out okay in the end, didn't it?'
If he's correct. But what did he do to relieve it?
Groused about it in the newspapers, and that's about it. He certainly didn't get involved in setting up alternate clinics that would do Modern Western Medicine for the people lying in the gutters.
That's my gripe there: sitting around talking about how terrible the problems are is useless unless it leads to action. What action will "we have lovely conferences in lovely manor house where lovely people get lovely treatment" actually result in? If it leads to concrete actions that measurably improve the lives of the deprived and suffering, great! But if it leads to "green papers about forming committees to perform preliminary investigations into setting up action plans to propose legislation", then it's simply navel-gazing. Very expensive navel-gazing, to boot.
> He certainly didn't get involved in setting up alternate clinics that would do Modern Western Medicine for the people lying in the gutters.
I see your point, but this seems like too strong of a position. You're not allowed to criticize anything, no matter how bad, unless you do something to improve it? What if I think a given situation is fine (or at least not in urgent need of fixing) and someone tries to "improve" it but makes it substantially worse? Am I required to try to undo their mistakes before even pointing out that they made any?
You do remember I admitted you were right about Mother Teresa and even went to the length of saying so on Zvi's blog, right?
I actually agree with you on this one. I thought the malaria nets in Africa thing made sense but once it got into 'longtermism' and 'earn to give' I figured they were deluding themselves into doing what they already wanted to do. It's human nature--evolutionarily derived from the development of reason to convince other humans rather than arrive at truth in my view, due to the Fallen nature of humanity in yours. But--six of one, half a dozen of the other.
That is the annoying part. It's not "we bought the manor house so we'd have a base for fundraising for deworming, malaria nets, solving child poverty, and doing tangible good works", it's one guy pushing "when I went to these big fancy conferences in the big fancy venues I found them really impressive, why can't we do the same?" and the justification is "we can have big fancy conferences where big-wigs fly in to sit around yakking about blue sky ideas while being wined and dined. The sick, the poor and the dying? Yeah well somebody else will look after them, right?"
The funders explained that they literally had too much money and didn't know what to do with it, so they ponied up for this. Now that, post-FTX collapse and scandal, money is drying up, they probably wouldn't do so again.
> The UK, Canada, Australia, and I think most other European countries also allow altruistic donation; Germany is a rare holdout here.
Strange. I can't imagine why the German government would be squeamish about organ donation from healthy individuals to random German citizens. Maybe if I concentrated I could figure it out. But there's six million other things I have to do. I'll try to think about it in the shower.
Actually, France allows you to donate your kidney only to someone who has been at the very least a close friend for at least two years.
"Le donneur peut provenir de l’entourage proche restreint, ça peut être : le père ou la mère, un conjoint, un frère ou une soeur, un fils ou une fille, un grandparent, un oncle ou une tante, un cousin germain ou une cousine germaine. Mais également toute personne apportant la preuve d’une vie commune d’au moins deux ans avec le receveur, ou bien d’un lien affectif étroit et stable avec la personne malade, là encore depuis deux ans minimum."
("Close friend" is an understatement; "lien affectif étroit et stable" sounds almost like "possibly platonic lover" to me.)
I’m actually mildly annoyed at the negativity of some of these comments. Mark Twain: “No good deed goes unpunished.”
How many of the commenters criticising Scott’s decision have actually met someone on dialysis? Or after a renal transplant? I think Scott quoted a disability adjusted life year improvement from 70% to 90% but this is a scale that ranks someone with chronic untreatable depression and constant suicidality at 40%. The commenter above who felt that his time on dialysis was basically a period in limbo awaiting transplant is a typical story. Nephrologists like to say that the dumbest kidney is still much smarter than the smartest nephrologist; our various mechanical systems are vastly inferior to an actual kidney in removing bodily waste. And it’s not a coincidence that dialysis starts with “die,” the median life expectancy is around 5 years.
Contrast that with a transplant recipient who in most cases after a period of recovery can expect a more or less normal life (granted, with the aid of strong immunosuppressive drugs), with a life expectancy of 15 - 20 years. You can perhaps appreciate how grateful such a person would be.
I have no strong feelings about the philosophy of EA, but I do strongly feel that a world where more people donate organs to those in need is a better world, notwithstanding the tiny and well documented risks involved to the donor. I understand that some commenters have a vague feeling of “yuck” but see how “yuck” you feel when you are in desperate need of a life saving transplant and there’s thousands of other people before you.
(I will probably not donate a kidney but only because Scott is a much better person than me.)
Having met multiple people on dialysis, I'm reasonably comfortable saying this is an incredible superogatory altruistic act, and that if he excised all of the EA hullabaloo from the article it would've been received much better.
I'm still thinking about donating and I have another dumb question. Why are there so many people on dialysis? Why isn't it the case that every person who needs one is able move someone who knows them to donate (I personally would have zero hesitation if I actually knew anyone who needed one)? Are their family members/friends/cowerkers/acquantances just sitting back letting them die?
Seems unbelievably stingy to me. Any insights on this would really help me to feel like I understand what I'd be doing.
There are several reasons for this, but one of them is that just because you are willing to be a donor doesn't mean that the person you are going to donate to will be compatible. The logistics solution for this is setting up donation "chains" where donor, recipient pairs keep getting added until 1. Someone gets added so the chain becomes a circle 2. A compatible undirected donation works on the "head" of a chain.
I think your take on the comments made me more uncomfortable with the original article after I went back and read it. Like some of the commenters you commented on, I'm trying to figure out why by writing a comment :)
TLDR: I'm glad you did it. I never downloaded the Good Person Who Just Wants To Help Human Personality Template. Kidneys seem safe to donate and have low long-term costs to the donor. I feel like you're moralizing about the best place to be on an ethical gradient when there is probably a vast savannah between the high moral peaks that EA/idpol/religious people get their climbing gear out for. I just wanna grill, man.
- I THINK the thing I'm uncomfortable with is something like "a lot of people are telling me how I should live my life and clearly a lot of them are dead fucking wrong, so why should I trust this guy?" The drive to moralizing and tinkering with optimal God Seeking Behaviour drives me wild! In my late 30s I finally came to terms with religious people who want to live under the thumb of ideology as long as they don't try to get in my face about it, just at the time when Social Justice types replaced God with identity politics and invented new idols to worship. Your framing feels like the same type of shape (triangular?) as the other God Seeking Behaviour, just using QAYL
- Any memeplex (EA, idpol, christianity) gradually gets more complexified and zealous. EA might have started out as "let's donate mosquito nets" and now is moving in to the "you should do this with your body" just like idpol started out as "this is how it feels like to be X identity, show some sympathy" and ended up at "because of your genetics you have original sin; pray with me it would be a pity if you lost your job"
- `[...] but I’m probably not going to donate a lobe of my liver [...] . 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`
- I'm pretty sure this is the sentiment that I just can't sign up for. You are judging on a moral gradient, and there are a lot of people out there judging on a moral gradient about how to be the best person. The axiology article is throwing a wrench in to me typing this during my morning coffee before work, but what if there is a vast savannah of "being pretty okay" between the high moral mountains of "being really good"? Is the imaginary Taylor Swift, Pumpkin Spice Latte, SUV commuter who donates to the food bank not measuring up or are they just "being pretty okay"?
- I have Hemophilia and it has been really shitty at times and maybe I would have loved to get a transplant from someone who could produce the clotting factor I don't (this is not a viable cure for Hemophilia AFAIK, but just ... what if), but also I absolutely hate being treated special after the first 20 years of my life being babied and coddled. I would rather be free from the obligation of a debt to a stranger. However, discounting that perspective by 30% is the fact that Pharma has done an amazing job managing Hemophilia with simple injectable clotting proteins and now some really wild antibody and gene therapy, so I have the luxury of a workable treatment that has meant I never wanted for a transplant
- Smaller considerations: I'm a bad person and kind of don't care about QAYL metrics when it comes to individual choices. I believe in society scale solutions (e.g. pay your taxes -> gov't research). I think our world would be better if more people were regularly taking Ecstasy at Ska shows, and having irresponsible sex and getting STIs than hunkering down and Being Good. All work and no play make Jack a dull boy, etc.
Georgist LVT + UBI seems like it could be a very efficient society-scale approach for enabling more people to take Ecstasy at Ska shows and so on. Anyone who prefers that kind of thing could simply spend their UBI cash on it without even being distracted by a conventional job, solicitation of charity, or means-testing. Somebody still needs to clean up any resulting messes, but would have reasonable options for getting paid a fair rate to do so.
That sounds good to me :) The troubles I imagine with UBI are in the transition period, like rents and food prices rising to meet 100% of the UBI granted to people. I'm not smart enough to know if a stable UBI system would feature $1B loaves of bread and $1T apartments, but I would expect UBI cheques in 2023 to directly increase rents and food prices like we saw with covid stimulus.
That's the beauty of funding it with a land value tax - if rents rise across the board, the tax base funding the UBI automatically increases to match.
As for food... well, there are already various entrenched precautions against food prices spiking too far, since that's been known to result in riots. In the industrialized world, food production capacity already consistently exceeds demand, so there's no need for extreme prices to allocate scarce resources, and if some agribusiness cartel tried to create artificial scarcity, they'd probably just end up destroying themselves and enriching their competitors, all the way down to migrant farm laborers and people with backyard gardens.
More likely source of short-term pain is folks with highly leveraged real-estate investments - such as every homeowner with an outstanding mortgage. They're the ones who'd be trying to stop it.
- I would rather live in a world where US/Can/UK/EU governments actually had the best science labs in the world and worked on insane future tech without the necessity of profit. The citizens of this world spend more time partying and enjoying life before their mind states evaporate upon death, than they do engaging in God Seeking Behaviour, because they know that quality of life is gradually ratcheting upwards because of the collective action. I believe this world is more achievable than an EA paradise of perfect individual action.
Being scolded for not being good enough tires people the fuck out and they just disconnect; see global pandemic/constant social justice warfare
Thank you so much for doing this. I will be likely receiving a kidney transplant in the next six months or so from my wife. I am incredibly grateful to her for the gift she is giving me and I know someone else is incredibly grateful for the gift you have given.
On the subject of legalizing donations for money: I know that the original post here labelled the "seduced by a hot stranger; wake up in an ice bath" scenario as an urban legend, but if kidney donations for money were legal and routine, how many actual organ thefts might occur? I am mostly worried about the developing world here, where people are more desperate and where a corrupt doctor or official might more easily fake the documentation that a recipient would demand.
I do not think donations for money are sinful or "deontologically wrong" or sinful, but I do worry about creating a market where organ stealing might get rewarded. Has anyone made an attempt to model or quantify this risk?
To riff on Galton-Erlich-Buck, "Altruists argued, with noble intentions, that we should implement a market for organ transplants in a responsible and ethical way. Eventually, people agreed, and they proceeded to implement a market for organ transplants in a horrifying way, with voluntariness badly compromised."
Given the (small in absolute terms) number of kidneys needed annually, the broad compatibility between donors & recipients, and the high unit value to even the US government of getting someone off dialysis, I expect an above-board market to comprise adequate supply that a black market would have insufficient demand to develop.
Some coercion and exploitation like that already happens. The usual argument would be that legitimizing and regulating such a market would give potential victims access to restitution through conventional channels, whereas if the whole transaction is criminal, they're mostly SOL.
A well-defined, matter-of-public-record price would also make it immensely easier for potential manufacturers of fully synthetic organs to secure financing, since they can simply point to an unambiguous "total addressable market" and promise to repay investors with a portion of that proven revenue stream if the invention succeeds. In that case, even if systematic exploitation did increase in the short term (despite the inherent benefits of transparency, and presumably some further active precautions), it would be a temporary downside of the faster path to a permanent full solution - "yanking off the bandaid" on a grand scale. I suspect very few would complain about such human contributions being replaced by advancing technology.
That being said, I don't at all think it's an illegitimate thing to be worrying about, particularly in the context of potential for jurisdictional arbitrage, and accordingly would prefer reducing such barriers incrementally, with opportunity to confirm net-beneficial results at each step, over, say, trying to skip straight to some wild anarcho-capitalist "anyone can auction off whatever body parts they happen to be able to cram in a box and pay freight costs for, no questions asked."
I am glad to declare that melatonin is now easily available in Germany. (One still needs a doctor's "Rezept" to buy sildenafil aka viagra). Kidney donation is still highly suspect and if it for money: *straight out of hell* as the German WaPo "Der SPIEGEL" shows in https://www.spiegel.de/international/world/the-illegal-trade-in-organ-is-fueled-by-desperation-and-growing-a-847473.html: "... According to Kishore, it is "paternalistic" and "dogmatic" to try to bar poor donors from selling their body parts, since doing so could provide them with a new life.
This may sound like a valid argument when it's posed as part of an academic theory. But it crumbles in the reality of the slums of India, Bangladesh, Egypt and the Philippines. There have been studies that included surveys of people in these countries who had sold a kidney. Many of them complained of poor physical and emotional health, and the overwhelming majority had spent the money within only a few months. Their lives did not improve. In fact, many were now worse off than before because they could no longer perform heavy labor or even work at all anymore.
Most had also failed to consider that the sale of about 160 grams of tissue would marginalize them even further, so that they would end up being relegated to the same level as prostitutes within the social structure of their countries. Moldovan organ donors told researchers that they were berated as "one-kidneyers" and "half-men," and told that now they would never be able to find a wife. ..."
"I do psych evals for surgery sometimes, and I’ve read the papers on how to do them, and the official criteria all seem pretty reasonable, so I have no idea where these people are getting this from or, how they possibly go so wrong."
I'm gonna hazard a guess at: lawsuits. I did a quick Google about "lawsuits for organ donation" and you get a nice selection of results where everyone is suing everybody else about "you took organs without consent", "you are sending harvested organs out of our state to the big cities", a really sad one about "the recipient contracted cancer from the donated organ and died" and plenty more.
Here's a lawfirm giving a handy rundown of "can you sue and on what grounds?"
"What Proof Is Needed for a Transplant Malpractice Claim?
In the context of a medical malpractice claim, professional negligence is negligence that is committed by:
Doctors;
Nurses;
Healthcare providers;
Hospitals;
Other institutions.
Professional negligence involves a failure to do something that a reasonably prudent doctor, nurse, medical provider, hospital, or other institution would do. Professional negligence may also arise when one of these parties does something that a similarly situated party would not do under the same circumstances.
Jury instructions that are provided in professional negligence cases ask that the jury consider whether or not the party on trial was negligent. The jury will be instructed to consider all opinion testimony from expert witnesses.
Can I Sue for Failed Organ Transplant Surgery Even After Signing a Waiver?
Yes, it may be possible for an individual to sue for a failed organ transplant surgery even if they signed a waiver. Waivers can vary greatly, so it is important for an individual to review what they are signing prior to their surgery.
A waiver is a document that indicates that the patient understands they are waiving their right to a claim. Medical waivers are attempts by service providers to avoid legal liability from injured patients.
Medical waivers are often very broad and will try to include all injuries and losses. Simply because an individual signed a waiver does not always mean it will be enforceable."
I can see hospitals deciding to err on the side of caution because of CONSENT CONSENT CONSENT*. Suppose someone donates an organ, then a couple of years later they regret that decision for whatever reason. Maybe they decide "I never really wanted to do that, it must be somebody's fault, it must be the hospital is to blame!" and they go see a lawyer.
"How did you feel the day of the operation?"
"Well, I was anxious and worried and scared"
"Did the hospital do anything?"
"No, they never asked me, just went ahead with the operation"
BINGO! The hospital failed in its duty of care to a vulnerable person, so now we're going to ask for $$$$ in damages.
So now all the legal advisers to the hospitals tell them to make sure to ask the potential donor how they feel.
"How did you feel?"
"I was anxious and worried and scared"
"What did the hospital do?"
"They asked me how I felt, and I told them, and then they went ahead with the operation"
BINGO! This was coercion, and we're going to ask for $$$$$ in damages!
So now the hospitals are advised that not only do they have to ask and make sure the donor still wants to go ahead with it, they can't go ahead unless the donor is happy to do so.
And no, having your staff psychiatrist chat to the donor for ten minutes before they go under isn't good enough, because the potential donor could feel persuaded/intimidated/coerced into going ahead. So you have to make sure they have plenty of time to be absolutely sure they want to do this. Hence the six months of therapy routine. Because all the legal decisions in cases that went before about "how did you feel"/"did the hospital ask how you felt"/"did the hospital offer you any guidance or support?"/"did you feel pressured into going ahead?" are now precedent for any subsequent court cases.
*Think of all the media articles about "sure, we were in a relationship and sure, we were having consensual sex but that one time I wasn't really in the mood but had sex anyway and now looking back at it five years later that wasn't consent so it was rape".
"The case before us involves the purported gift of a kidney to plaintiff.[FN*] He asserts that as the specified donee of the organ, he{**8 NY3d at 47} acquired a property right in it, giving rise to claims [*2]against defendants for delivering it to someone else. Plaintiff brought suit in federal court, and the United States Court of Appeals for the Second Circuit has certified questions to us relating to whether he has rights that would support his common-law conversion action or a statutory claim under Public Health Law articles 43 and 43-A. I
In August 2002 Peter Lucia died at defendant Good Samaritan Hospital on Long Island, from massive intracranial bleeding. His widow, Debra Lucia, sought to donate his kidney (or kidneys[FN1]) to plaintiff, Peter's longtime friend who had been suffering from end stage renal disease. Debra proceeded by going through defendant New York Organ Donor Network (NYODN). NYODN transplant coordinator defendant Spencer Hertzel concluded that Peter's kidneys were "not a perfect match, but they [were] good enough." Peter's left kidney was airlifted to Jackson Memorial Hospital in Miami, Florida, where plaintiff was awaiting its transplantation; Peter's other kidney remained in New York.
While preparing for the transplant during the early afternoon of August 23, 2002, Dr. George W. Burke, a surgeon at Jackson Memorial, inspected the donated kidney and discovered an aneurysm of the renal artery, making the kidney unsuitable for transplantation. He immediately contacted NYODN, asking for Peter's other kidney, and was informed that it had been allocated to someone else. The parties agree that NYODN had allocated the other kidney to another patient at about 11:25 a.m. that day."
From 2008, a real life version of the Surgeon Thought Experiment:
"On a winter night in 2006, a disabled and brain damaged man named Ruben Navarro was wheeled into an operating room at a hospital here. By most accounts, Mr. Navarro, 25, was near death, and doctors hoped that he might sustain other lives by donating his kidneys and liver.
But what happened to Mr. Navarro quickly went from the potentially life-saving to what law enforcement officials say was criminal. In what transplant experts believe is the first such case in the country, prosecutors have charged the surgeon, Dr. Hootan C. Roozrokh, with prescribing excessive and improper doses of drugs, apparently in an attempt to hasten Mr. Navarro’s death to retrieve his organs sooner."
"On Nov. 17, 2017, Brittany O’Connor tried to kill herself by strangulation. She was rushed to Community Regional Medical Center in Fresno where she was not expected to survive. What happened next is the focus of a Fresno Superior Court civil lawsuit that pits her father against Community Regional Medical Center and Donor Network West, a multimillion-dollar nonprofit that connects organ donations to people in need of transplants in 40 counties in California and Nevada. In his lawsuit, Terence “Mike” O’Connor Jr. accuses Community Regional Medical Center and Donor Network West of harvesting his daughter Brittany’s organs without his permission. His attorneys, Fresno lawyers Thornton Davidson and H. Ty Kharazi, contend it’s not the first time Community Regional Medical Center and Donor Network West have skirted the necessary approvals. They have accused the two entities of engaging “in a pervasive and unlawful scheme to harvest organs from terminal patients” by denying other parents, guardians or their lawful representatives the right to object to an organ donation."
On the pig kidney thing, my partner works for the company doing that work, and it has been really interesting to hear about it from a laymen without a science background. She even got to visit the genetically modified pigs. One fun fact about them: if you have a red meat allergy (like from the Lone Star Tick) you can still eat the meat from their pigs, because they are bread without the protein which your immune system incorrectly responds to.
While I believe that so far they only attempt at kidney donation has been hooking the kidneys up to a patient who was in a coma, my understanding is that it went pretty well? The test stopped because they pulled the plug, so obviously the long-term impact has not yet been studied.
The more newsworthy donation attempts have been two heart transplants on recipients who did not qualify for transplant and were about to die anyway. The first lived for two months but eventually succumbed to pig herpes. The second seemed a lot more promising and was doing well until dying suddenly 6 weeks after surgery. The reasons for the abrupt failure are not yet public (and might be unknown by even the involved team, I don't have any non-public information on this one).
If anyone has any questions I'd be happy to ask my partner about what information she can provide that is sharable.
Seems like the problem of bridging from organoid to organ is that it's too complex a development process to understand/direct at the microenvironment level manually. But wouldn't most of those signals be interoperable with, say, porcine signals in a developing fetus? What if you identified the somatic cells in a developing pig fetus that are destined to become the kidney, then exchanged them with human cells at that point (post-fertilization)? It would be delicate work, of course. Back in grad school I had an opportunity to try out the system they used for SCNT and it was really tricky. But if it worked, and you could transfer a human renal organoid into a developing pig fetus, the pig's system would take control of all the signals to create the structures that are too complicated to direct in vitro.
I guess the biggest problem with that approach would be if the vascular endothelial cells originated from the pig and not the human cells. Then you'd end up with rejection due to vascular collapse after attempting to transplant. Is this something they've tried and rejected as unworkable?
Something I forgot to ask on the original article, but that I’m still wondering about: how much difference does it make, both for the donor and the receiver, *when* then donor donates? Would there be a benefit/detriment to either if a prospective donor that is 25 years old waits 5 years, 10 years, 20 years, 40 years before donating?
>"if someone invents something new which is approximately as body-integrity-violating but also >approximately as beneficial as vaccines, Stephen will support it."
At this point we can easily imagine sci-fi style robotic/cybernetic/whatever implants being available by the end of our lifetime. Pacemakers are already kinda-sorta that. But there's a shared revulsion to these things, even among sci-fi fans who are already pro-science and imaginative. Star Trek's main villains for the past 30 years are the Borg. Star Wars villain Darth Vader is considered an abomination for being "more machine than man, now". Even the genetically-enhanced doctor on Deep Space Nine is afraid to continue adding cybernetic implants to an important religious leader and friend, on account of a fundamental fear that what comes out the other side would not be the same man. Point being, even a futurist open-minded audience shares this heuristic and has a visceral fear of crossing certain lines with regard to bodily integrity.
I would assume this commenter would decline robotic implants. "Hey you let us put this vaccine in you to boost you immune system, why won't you get this robot eye that sees 1000 yards and lets you change your eye color at will?" There is a primal sense shared by most people that you don't want to mess around too much with your body, ancient cultures were frightened by tales of chimeric creatures, and most in modern society find it unsettling to see people with bizarre piercings all over their body.
I don't think donating a kidney is disgusting in that way, I'm glad Scott feels good about having helped somebody even if it's not the sort of thing I would do. But I definitely have a tendency to view the body as a system you can horribly wreck by tinkering around with a thing here and a thing there, and that our incomplete knowledge of the body leaves a lot of room for me to fall back on "for every intended consequence, there's 3 unintended consequences". Normalizing kidney donation may well be a net benefit, but there IS a line beyond which I would not want to normalize screwing around with our bodies even if it it was beneficial on the face of it.
Intellectual contortions presented as moral reasoning that invariably culminate in an altruistic obligation. All of this ignoring epistemic difficulties like The More Data You Have, The Further You Are From the Truth (https://www.youtube.com/watch?v=fuFzv1AwBKQ) and how the removal of a kidney is exactly the sort of situation that ought to evoke Chesterton’s Fence (https://fs.blog/chestertons-fence/) type trepidation. Human physiology is complex to an extent that our modern understanding, robust as it may be, cannot reasonably dispel such hesitation.
The motive behind your crusade is a conception of altruism that I find offensive, one that insists we extract and metricize our virtue, that our sense of self-esteem ought to be derived extrinsically. You shouldn’t feel good about yourself unless you justify your existence through others. Forget yourself and serve the common good, and you can bask in the feeling of pristine self-righteousness, crowd-surfing on imaginary borrowed esteem. But it doesn’t satisfy the feeling of moral insufficiency that compelled you in the first place, so you seek to convince others as a form of reaffirmation. In this way, it’s contagious – like religion.
I might donate a kidney to a close friend, but nothing could ever convince me to donate one to a random stranger, and I think the impetus to try is deeply immoral. I don’t suspect you of lying, but I’m terrified of what you honestly seem to regard as moral action.
Well, you haven't discovered why the chesterton's fence exists (or else you would have explained why undirected donations are violating the no doubt very good reasons for not giving), nor apparently do you have enough data to say that donating the kidney is net good for your friend, which is why I presume you linked to a video explaining why cancer treatments can be confounded by a naive reading of the data, hoping to draw a parallel between that and donation.
You've misunderstood the objection entirely. There is absolutely sufficient evidence that kidney transplants are lifesaving, whereas there is no chance whatever that we have a comprehensive understanding of the totality of consequences involved in removing a healthy person's kidney. My willingness to face the uncertainty of those consequences for a friend, but not for a stranger, constitutes neither a contradiction nor a moral shortcoming. I submit that the desire to conflate these two actions, and call it altruism, does.
I mean, you were the person who invoked chesterton's fence on this entire affair and I still do not see how what you said actually takes down the fence, other than "because I thought my friend is more important than the fence", in which case what is good for the goose is good for the gander. Most people in fact do not donate kidneys to their friends, so it sure looks like you're not obeying your own precepts and ignoring Chesterton's fence.
I think this type of donation to friends is excessively self congratulatory, especially considering how immoral it would be to donate to a friend when a family member could need it too.
In fact, even when a family member gets a failing kidney, they need to understand that you have to put on your air mask first and that not donating is in fact the best possible outcome. After all, people who donate their organs to family members do have markedly higher esteem and mood afterwards, which just shows you how suspect the foundation for this entire house of kidneys are.
You seem really hung up on my invocation of Chesterton's Fence, but you've misunderstood how it fits into my argument... again. I'm going to take one more stab at explaining this.
Since our working knowledge of human physiology is incomplete, we can't know what sort of long-term (or nth order) effects removing a kidney might have. Therefore it's perfectly reasonable to maintain reservations about the procedure. This is true even when you present a bunch of studies to demonstrate that the operation poses little risk (as it's defined by the study) to your well-being (as it's defined by the study).
Chesterton's Fence is just a principle expressing the logic behind that sort of hesitation over unforeseen consequences. The reason that I invoked this principle was to make the point that, if somebody is concerned about the potential, unforeseen, long-term (or nth order) effects, they shouldn't care about the relatively narrow metrics presented in the relatively limited studies.
If you're perfectly happy to sacrifice your life in the process of donating your kidney to a random stranger, you needn't worry about the risks. But at that rate, why stop at a kidney? If the benefit (as measured in QALYs) to any random stranger outweighs any potential, unforeseen consequences to your own body, just check the donor box and prep a noose (I'm not trying to be glib, I just genuinely find this particular line of thinking personally horrifying).
As far as your comments on morality are concerned, I'll direct you to my reply (in this thread) to Tom Hitchner, since I've already expressed my feelings on altruism there.
So it seems like you agree that giving a kidney is altruistic (since it’s sacrificing an undetermined amount of well-being to save a life) but that encouraging that donation is not altruistic, particularly since (in your view) the unknown costs are too great to justify the benefit to a stranger. So your objection is not to Scott doing it, but writing about it, or at least the way he wrote about it. Is that fair to say?
Is the problem possibly the idea of a “shortcoming”--you’re picking up from Scott the implication that someone is morally deficient if they don’t do this? I feel like that’s more binary than Scott was implying. An analogy to financial altruism might be helpful: all else being equal, giving 10% of one’s income is more admirable than giving 0% or 5% or 9%, and less admirable than giving 12% or 15%. But that doesn’t mean that giving 10% or 5% is a “moral shortcoming,” partly because all else is never equal and partly because, since no one can give 100%, there isn’t a minimum level of contribution we can set, short of which we have a “shortcoming”; we have to work out the contribution that we’re able to make, and strive to make it as big as we’re comfortable with.
First of all, thanks for actually taking the time to read my comment. You're a breath of fresh air compared to the other guy who seems to be popping off for no reason. I can tell you've really tried to understand my position.
That being said, I think you're reaching a little in the search for common ground. My issue is with altruism itself, which shouldn't be seen as having a monopoly on human decency. The notion that selflessness ought to confer some moral value to an act, leads to absurdity. Selfless beneficence becomes the unobtainable moral standard for virtue, and people scramble over themselves and each other in search of an act that nobody could suspect of selfish motives.
[EDIT:
I should mention that the inevitable conclusion of this Race to the Bottom looks something like how Scott describes the experience of his prescribed kidney donation:
> "It starts with wanting, just once, do a good thing that will make people like you more instead of less."
> "You want to do just one good thing that you’ll feel unreservedly good about[...]"
> "When I woke up in the recovery room after surgery, I felt great. Amazing. Content, peaceful, proud of myself. Mostly this was because I was on enough opioids to supply a San Francisco homeless encampment for a month. But probably some of it was also the warm glow of having made a difference or something. That could be you!"
The dogged pursuit of a clean moral action probably speaks volumes about how a person regards their ordinary, everyday existence. I realize that the implications of this could seem insulting, but that's not my purpose.
/EDIT]
Convince people that selfish acts are dirty and selfless ones are clean and they'll spend the rest of their lives with a unshakeable feeling of moral insufficiency. They'll resent themselves for constantly getting in the way of their own righteousness, and they'll adopt self-censure as the guiding principle of their lives. Altruism is, in this way, antithetical to self-determination.
If I donate a kidney to a dying friend, it won't be altruism motivating me. Not a selfless concern but a very selfish one, which is - in my submission - the source of all genuine acts of kindness and human decency.
Scott's comment in Section 5 of "it seems borderline enough that I’m still sticking with my heuristic of “IDK irradiating my body seems high risk of being bad” and his further offhand comment in Section 9 about being "way way way outside the bounds of common sense" strike me as pretty decent refutations of his rebuttals offered in Section 1. It seems, at least, non-standard to judge a tiny radiation risk from a procedure most people do without much worry, more seriously than 'IDK removing an organ seems high risk of being bad,' and that would bring it into the realm of "common sense," to which Scott later appeals. I don't think his interlocutors are arguing much differently than he is, just with different "IDKs" and "common sense."
Bear in mind that a multiphase abdominal CT has roughly 4x as much radiation as a standard abdominal or chest CT. Most people, especially young people, would (or should!) have some anxiety about doing four CT scans back to back
OK, but most people, especially young people, would (or should!) have some anxiety about losing half their kidney capacity. That's the point; the arguments are isometric.
Strictly speaking it’s less than half the kidney function because the remaining kidney hypertrophies to some extent. But OK, call it 30% of kidney function, still a significant amount.
I think the point here is not to discount the ~1% chance of going into renal failure in older age as a result of kidney donation (which is similar order of magnitude to chance of developing cancer from multiphase abdominal CT; call that 0.2%); the point is that it’s a small risk to take compared to the benefit for the kidney recipient. It’s quite an altruistic act.
I suspect if you asked Scott if he could somehow produce a kidney by undergoing a multiphase abdominal CT scan and accepting the risk of cancer that entails, he would say yes to that too.
You get priority for future kidney transplants, and for your family too or did I remember that wrong?
Based on LNT his extremely cautious ex GF found the risk to be massively higher. It may actually be roughly equivalent even if LNT is quite false as it's in the threshold zone
"Here’s a sort of daydream: some charity gets the list of the 40,000 people who are predicted to die next year for lack of a kidney. Then it chooses 40,000 random Americans in a 1:1 correspondence with the kidney patients. Then it sends each of those random Americans a letter, saying “Dear John, you have been paired with Bob Smith of Topeka, Kansas. He will die of kidney failure next year unless someone donates a kidney. We have randomly selected you as a potential donor. If you say no, we will not randomly select anyone else, and Bob will probably die. If you’re willing, please call this phone number.”
There’s some sense in which this charity would be doing zero work - just choosing random names from the phone book! - but it sure would be an interesting experiment. Would 25 - 50% of the people involved really go for it? I don’t know."
Two possible answers from me (and the second is the much more likely one):
(a) "Dear Prodnoses, I am terribly sorry to hear about poor old Bob. Certain to die, you say? In that case, for the minimal sum of, let's say, five million dollars I'd be more than happy to give him one of my kidneys. You cannot put a value on life, after all, so I'm sure Bob and/or his family would be willing to recompense me for the time and inconvenience in order to save their loved one. Bank details to follow as soon as you send me acceptance of my terms, love and kisses, Two Working Just Fine Kidneys-Haver"
(b) "Dear Busybodies, I'm sorry to hear that Bob is in such dire straits. From a sudden and unprovided death, deliver us, O Lord. However, since Bob knows his death is nigh, he will have time to prepare for it, and isn't that a blessing? This bit you include about kidneys, I'm not entirely sure what you are hinting at. Since I don't know Bob or the sky over him, why am I going to give him a kidney? You are labouring under a misapprehension there, my friends. Well, best wishes and tell Bob I'll pray for his departed soul! Your friend, Taking All My Bits With Me To My Grave".
(2)
"Comments From People Who Are Against This Sort Of Thing"
A bunch of people I don't know randomly select me to try and armtwist me into donating an organ to a stranger, and *I'm* the jerk?
Look, most people are going to go "will I get paid for this?" or "I have no idea who this guy is, I'm not obliged to help him". If that's being a jerk, then okay: we're jerks.
People who want to donate are admirable. But trying to emotionally blackmail strangers into donations out of the blue is not going to work.
> trying to emotionally blackmail strangers into donations out of the blue is not going to work
...I mean, elsewhere, it demonstrably does?
Charities do in fact raise money by randomly sending letters / going door-to-door / accosting people in the street asking for donations to help complete strangers, and successfully get a large portion of their funds this way.
Blood banks also do this kind of thing and get some donors signing up this way.
I support kidney donation, yet I have to grudgingly agree with Deiseach on this one. The method outlined by Scott in the OP seems like a flagrant violation of bioethics. I do clinical research, and if we worded our informed consents anything like how it's worded by Scott we'd get a strongly-worded IRB rejection letter in return. And in this case I'd agree with the decision. ICH GCP strongly prohibits this kind of coercion, and with good reason. We've walked that path before in medicine and it led to bad places.
But also, this reminds me of the debate back in the Bush era about public funding for stem cell research. Personally, I have no ethical problem with it, but I also recognize that *public* funding requires *public* support. I knew people at the time who strenuously objected to the research feeling it was a deep betrayal of their ethical standards. The idea that their government used their taxes to - as they saw it - commit atrocities, spurred them into activism and distrust of public research funding in general. At the time, I heard arguments from the other side, saying we should ignore the naysayers and publicly fund it by any means necessary. They cited the many people who could benefit from the short-run ideal of running rough-shod over having to seek public support.
As someone who saw the benefit and disagreed with the ethical harm, I nevertheless sided with rejecting public funding. I don't want support for research funding to become the next battle ground in the culture war. Same with kidney donation.
Unless we get widespread adoption of tens of thousands of lab-grown kidneys in the next few years (probably <1% chance) we're going to be relying on the public supporting kidney donation MORE. It seems like burning this bridge wouldn't just prevent us from getting back to the other side of the river, but also prevent us from getting the reinforcements we know we need.
Chuggers get the boot from me. I once made a donation to a charity and like an idiot signed up to a list or at least allowed them to have my details.
End result? Streams of collectors to the door asking me to sign up to donate X percent via direct debit to Good Cause. I got to the point where I could recognise them on sight. I have been brusque to perfectly nice young people volunteering to do some charity donating fundraising campaigns, who were sent out with address lists of "these suckers gave money before, arm-twist them into agreeing to hand over their bank details", which was not their fault but the fault of the charity, or rather whatever marketing consultant advised the charity that this was a bonzer idea.
End result was that no matter what heart-rending emails or mass mailing campaign letters in the door I receive, they all go straight into the bin. I am happy to donate occasionally, but not to be treated as a milk cow forever and a day. They've lost more money by trying to emotionally blackmail me, because now I don't give them *anything*.
Limit the mailing list to people who've already signed up to donate organs in the event they die in a car crash, then. If 80% still refuse, and 80% of those who accept fail the health screening, then for each life saved you've irritated and inconvenienced maybe 20-30 people, or roughly a million per year (just 0.3% of the overall US population) if scaled up far enough to clear the waiting list completely. Folks on the losing end of such a policy can be compensated out of the savings from reduced need for dialysis.
I do think that would work much better; sending out a letter to Bob Smith who signed up to "yeah I'll donate my organs upon death" will have a better chance of "Huh, there's actually someone right now who needs my kidney? Lemme think about it" than simply random Bob Smith who gets a ton of junk mail in the door anyway and is half-inclined to think this is some kind of scam: "Sooooo... you're telling me that there just so happens to be this one guy who is a perfect match for my kidney and who will die unless I donate *right now*? Even though I don't remember signing up for any kind of organ donor list? And I suppose he's also a Nigerian prince who will send me on five million dollars if I agree, yeah this one is going into the recycling".
(c) "I understand that donating a kidney can be a difficult choice to make, and I thank you for choosing me to assist you in this cry for help. I would only be too happy to facilitate the process of donating your kidneys and other organs. Alas, you neglected to include your home address, and although this oversight was easily remedied, your distance from me makes a personal intervention impractical. However, I passed your request on to some local associates who assure me that they can provide a swift resolution to your problem."
I loved your article and forwarded it to my sister-in-law in Holland. She is donating a kidney to a nurse she works with. She chuckled at parts of the article. You did a beautiful thing in donating a kidney. Thank you for sharing your experience!
Not sure if this has been mentioned before, but it strikes me that the moral agency here being discussed is completely contingent on outside factors. However thorough your due diligence prior, your action stops at the door, and from thereon everything depends on a complex system of interventions, care, proper organ transport, etc. to work at near perfect levels - and for it to continue to do so. And we happen to be talking about a system where medical error is a leading cause of death or harm. I am speaking as a former ICU nurse (who has also seen 10/10 pain coming out of ORs).
There are a lot of moral actions that rely on outside factors, of course, but in such cases you can generally change how to direct your resources. I think our morality is based in intuitions without which no-one would care about rational arguments, and which prioritize observable and close effects over remote and theoretical or statistical ones - for good reason.
The action also requires consent. This is and should be a hard line in society and signals that it is not enough for something to be for the common good to be socially prescribed. You are doing something wonderful - but something that cannot be asked of anyone. A significant distinction morally, I think.
Of course, your rational arguments also occur in the context of a society where consent and individual agency are prioritized. But is it hard to imagine a highly top down society, maybe not to far removed, siding with your impeccable arguments, and distributing resources accordingly?
So what I am arguing is that seemingly universal principles can be very contingent.
I am all for individual people donating their kidneys and I think they are heroic, but a social norm where you had to donate kidneys to be considered a real effective altruist and get access to high level business networking events is pretty horrifying but also the most plausible negative outcome, requiring only that in 50 years EA reverts to the mean and starts working like normal charity fundraising, or like a normal social group, on one of the advanced levels of that "reality/imitation/symbol/imitation of a symbol" hierarchy that I don't recall the name of.
The best way to avoid this that I have thought of is to talk about how great and selfless individual people are while loudly proclaiming how unsettling it is *in general*, so that it can never become a social norm that you have to do it to be average within this extreme community.
Isn't there a more obvious objection that you can only donate a kidney once? If you give your kidney to a stranger, you can't also then give one to a dying loved one. Since (almost) everyone values loved one lives over stranger lives, there's some calculation to be done in terms of EV. Quick googling says 2/1000 Americans actively need transplants, and 1/7 adults experience kidney disease. Assuming you have at least 10 loved ones including yourself, you have to value a stranger's life at least at 1% of your own/loved ones' to make this decision.
Which is why the "if you donate altruistically, you can put 5 loved ones on the top of the transplant recipients list if they ever need a kidney" perk is very important.
Sorry if I missed it, but is this something that actually exists? I thought just you personally get higher priority if you donate a kidney (and some sources suggest even that is subject to change).
cool paradox with being protective of potential donors being "neither selfish nor altruistic". But idk it seems pretty obvious to me
Surely if someone was mistaken about their risk from donating (e.g. had some disease that would make it massively reduce their quality of life), you would tell them that, even if you thought them donating would still be net +utils. It's like honesty. This would be true even if the donor would never connect the dots and wouldn't regret the donation.
People who feel very uncomfortable with donating a kidney feel like their discomfort (to some degree) applies to other people too, that is they're making a bad decision for themselves. It's the same things as not stealing from the rich to give to the poor etc.
(I note I'm (somewhat) one of such people and my analysis presents us as pretty cool)
I was really surprised at how much pushback you got for donating your kidney. Really strong, emotional feedback in many cases. I don't really get it.
After talking with some commentors who were upset with your post, I think part of the issue is the whole morality/axiology thing you mentioned. I think some people believe that is something is morally praiseworthy then it is morally required, and if you don't do it then you're a bad person, and this translated your kidney donation post into "if you don't donate a kidney you're a bad person" even though you kind of went out of your way not to say that.
Maybe it's because I'm a Christian that had "all men have sinned and fallen short of the glory of God" hammered into my head from an early age, but it seems clear to me that you're not trying to make anyone feel guilty for not donating their kidney. None of us are anywhere close to morally perfect, and that's okay.
I was also surprised at the pushback and I mostly agree with everything else you said, like the analysis of why people were offended, except for your last sentence. It (by definition I would argue) is not okay that we are not close to morally perfect.
Anyway, I think a lot of people think that everyone is ”basically a good person” unless they do something bad to lose that status, and don’t have the sense that being good is something that requires work, like being a good flute player, for instance.
I guess by "that's okay" I meant "that doesn't make you much worse than the average person". If nobody is perfect then it's "acceptable" to be imperfect.
>I think some people believe that is something is morally praiseworthy then it is morally required, and if you don't do it then you're a bad person, and this translated your kidney donation post into "if you don't donate a kidney you're a bad person" even though you kind of went out of your way not to say that.
I mean, he closed the essay saying people should consider it. He's not exactly calling them bad if they don't but it's not exactly *not* implied.
I'm pretty sure Scott knows the word "superogatory" and chose not to use it.
As well, the whole EA aspect. Even though Scott has pushed the 10% pledge as a way to short-circuit moral intuitions, there's a point where... if it's true that we don't have to be morally perfect, there should be a "good enough," but EA does not strike me as particularly good at letting people rest on their laurels like that (the veganism is most notorious). You'll always get cultural nudges to do something else or to do something better. For it to be okay that you've done enough, I think you'd have to disconnect from the community and just have donations on autopilot.
Likewise, here. Scott did not feel "good enough." Not only did he find something else good to do, he spent a great deal of time, money, and health to do it!
I mean, going with the same sort of Christian perspective as the original post: it is made clear to us that sinning is part of the human condition but crucially we should all make an effort to be better. So the translation should be we should all be okay one the sense of being accepting of the fact we will never be morally perfect, but we should still strive to be better. You know, in the same spirit as the whole Rationalist thing of being "less wrong".
"You know, in the same spirit as the whole Rationalist thing of being "less wrong".
EA therefore needs to establish its own version of casuistry, in order to avoid binding too heavy burdens on its adherents, and to relieve the consciences of those afflicted with scrupulosity or OCD:
"The application of general principles of morality to definite and concrete cases of human activity, for the purpose, primarily, of determining what one ought to do, or ought not to do, or what one may do or leave undone as one pleases; and for the purpose, secondarily, of deciding whether and to what extent guilt or immunity from guilt follows on an action already posited.
...Since the special function of casuistry is to determine practically and in the concrete the presence or absence of a definite moral obligation, it does not fall within its scope to pass judgment on what would be more advisable, or on what may be recommended as a counsel of perfection. It leaves these judgments to the sciences to which they belong, particularly to pastoral and ascetical theology.
...The necessity of casuistry and its importance are obvious. From the nature of the case, the general principles of any science in their concrete application give rise to problems which trained and expert minds only can solve. This is especially true regarding the application of moral principles and precepts to individual conduct. For, although those principles and precepts are in themselves generally evident, their application calls for the consideration of many complex factors, both objective and subjective."
EA casuists could therefore give practical guidance in individual cases about "am I obligated to donate a kidney?"
The Christian perspective is not the rationalist or EA one, though. Historically most rationalists (Scott being the notable exception) were fairly hostile to religious sentiment, even.
That at least Scott (and I think much of the broader movement) have this scrupulosity drive, of sin-debt without a saviour, can lead to some weird places. A Christian can strive to be better while knowing, ultimately, Christ has paid their price. It gives a comfort the EA-rationalist can never have, and if the EA-rationalist doesn't have the personal will to fill that gap instead? The EA-rationalist only has a bottomless pit of suffering (https://slatestarcodex.com/2014/09/27/bottomless-pits-of-suffering/) and how much of themself they're willing to toss into it.
Section IV of his What We Owe the Future review (https://www.astralcodexten.com/p/book-review-what-we-owe-the-future) comes to mind too, and I wish he'd elaborate on how that *doesn't* invalidate... a lot of EA and his intuitions here? A lot of people choose to stay on World A with their kidneys and good food instead of making all those logical leaps that wind up cutting off bits to sacrifice in the bottomless pit.
Mind you, I do think he did a very good, extremely generous thing. I also think it's irrational and that trying to put a veneer of rationality on it requires a lot of other sacrifices (I will be somewhat surprised if Scott *does not* donate of lobe of his liver within 5 years), or one has to admit that the veneer of rationality is just culturally-afflicted rational*izing*. My problem is less with giving the kidney and more with the EA/rationalist gloss on what is not justifiable in those terms.
I never equated EA with Christian morality. I merely elaborated on how the standard Christian stance of accepting imperfection whilst striving for "perfection" should make it easy to accept that Scott can justify the goodness of his donation without implying that everyone else is morally obligated to do the same - like all Christians aren't obligated to live off locusts and honey and literally give all their possessions to the poor. In this I was merely supporting the original comment.
On a separate note, I don't see how you can read Scott's whole two posts and call his decision irrational. It is perfectly fine to disagree with it on many different grounds, but it seems to me like a solid consequence of the moral axioms that Scott starts from. Regardless of whatever else his decision may be, it is not irrational.
What's a reasonable number of people? 5, 10? 5 million, 10 million, 100 million? Just kidneys, or kidney and liver lobe? Maybe donating just one eye, you can manage with the other (like the kidney).
Maybe they could. Maybe they could then rest. Or maybe, like the poor that will always be with us, some people will always need A Cause.
The pit isn't bottomless, because the universe is finite. But I suspect the Pit of Possible Causes, while not bottomless, has a tendency to grow in proportion and stay larger than the Line of People Waiting to Fill It In.
Maybe I'm too pessimistic, here. Or maybe I'm just back on World A with that Scott, instead of the Scott that made a few leaps closer.
Maybe "the poor will always be with you" was specific to preindustrial contexts. Polio sure seemed like it would "always be with" humanity, until we decided to change that. Lot of kidney and liver problems are preventable, or curable without a transplant. Broad "nobody-gets-left-behind" policy can be a key part of the political pressure driving such treatment methods to be developed and implemented.
"if it's true that we don't have to be morally perfect, there should be a "good enough," but EA does not strike me as particularly good at letting people rest on their laurels like that"
Yeah, that's the scrupulosity trap right there. If you've logically argued yourself into doing something rather than basing it on 'warm fuzzies' or a gut feeling, then it's much more difficult to resist going the extra mile - "if A, then B; if B, why not C?" and so on.
Had a random thought reading this article, EA:Charity::Sabremetrics:Baseball
Meaning, people acknowledge that the statistical modeling that's been added to baseball is invaluable if you want to actually win the most games over a season, so it would be irresponsible for coaches and managers not to use it, but a lot of fans of baseball feel that it ruined the thing they loved about baseball, which wasn't actually the number of games won but the narrative experience you could randomly have watching a game where something totally unexpected would occur and you would define part of your whole life experience as being present for that moment (the classic example is seeing someone throw a no-hitter, which you will never see in the modern game because its mathematically irresponsible to leave one pitcher in for an entire game).
Anyway, EA is great at the thing that most people would assume people engage with charity for, which is helping people. But it dilutes a lot of the narrative aspect of charity that is what people really want whether they acknowledge it or not; instead of charity being a magical moment of self-discovered selflessness, its some mathematically quantifiable that can tell you, objectively, the extent to which you are really optimized for "helping other people."
Anyway, I think donating a kidney obviously sort of bridges the gap between these two experiences.
Its a very personal story where the cost-benefit analysis is still something someone in EA would accept.
A lot of the baseball issues are just exploiting problems with the rules, and could be fixed by correcting the rules. For instance, relief pitches should be banned or at least strictly limited.
I'm not sure about that. Effective altruists speak my language and lay bare my total instinctual aversion for all of their altruistic goals, but simultaneously I'm forced to admit they are the only rational approach, leaving me retroactively averse to the old altruism for which I had less instinctual distaste. After realizing I just would never give up a kidney no matter how safe and easy or how much it could help someone, I'm forced to admit a mosquito net is not worth my time and money no matter how cheap or helpful it could be either. I prefer to be, and will force myself to be, consistent; EA pointed out that for me, consistent selfishness is far far easier to achieve than consistent altruism. They are right about the E so I had to discard the A.
Would you not consider that a mosquito net is a much smaller investment of time and effort and sacrifice than donating a kidney, so it might be worth it because the benefits greatly outweigh the cost? I can see the consistency in "if I'm not going to do X, then I shouldn't do Y either", but again - "a foolish consistency is the hobgoblin of little minds". You don't have to be perfectly consistent every minute of the day, you're only human!
Cool story, but please forgive me if I find it psychologically unlikely. I can't imagine someone who donated money to buy mosquito nets, but after reading an article about kidney donation decided that kidney donation is too much and therefore for the sake of consistency the mosquito nets need to stop, too.
I can more easily imagine someone who *contemplated* donating to buy mosquito nets, but then decided that it's not worth it, because people who donate kidneys get more status anyway, so what's the point.
I think my opinion is relatively simple: it is obviously a Good thing to donate organs, but most people (including me) are not particularly Good. Which is fine, really, being Neutral is fine and all that should be expected of anyone. It's just weird when some people feel the need to define Good in terms of the decisions and sacrifices they personally would make.
> 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?
First of all, I don't believe it is net positive. It certainly has some positive effects, but I value a working organ more if it's working in its true owner, not someone else, ceteris paribus (sort of like how kids should be raised by their biological parents). Then there are the nonphysical negatives like the OCD/scrupulosity issue or the self-harm / self-negation issue.
But even if it were *net* positive (say it saved 1000 lives), I don't think people should make major sacrifices of their own body just to help a stranger. I think it's wrong. I think that's a harmful and self-destructive thought process, and I'd like to see it eradicated.
These discussions have made me realize that part of the reason barriers on kidney donation make me so mad is that they are an imposition onto me of the values of the medical ethics community that values status quo and not doing harm over improvement. An imposition of exactly the kind that medical ethicists insist would be immoral to do with respect to other values -- creating the impression that I'm being disrespected for being different.
In general, medical ethics requires we respect the choice of a patient to decline treatment even when the doctor is quite confident that not only will it benefit the patient but they'll retroactively appreciate it. Even if treating a patient whose mental illness has caused them to develop strong religious beliefs that cause them to oppose treatment (but still legally sane) medical ethicists hold that it wouldn't just be unwise but unethical to override that patient's own value judgement: even when that value judgement is to do something which they'll regret in the future.
Moreover, it wouldn't be ethical for a doctor to use coercive power they had over a patient to pressure them to accept. Sure, the doctor can try to persuade but they couldn't withhold some other needed medication unless the patient sees a psychiatrist who will try to convince them to take the drug they choose not to take, or to force them to get all sorts of other tests they don't wish to get to convince them they should follow the doctor's advice.
But yet when my ethics say that I care very much about not weighting the potential harms to myself over the benefits I'm told too bad we'll force you to do exactly that by creating a bunch of hurdles.
One thing that seems overlooked is that, even if it's ok to donate a kidney to a stranger (which is doubtful), it's definitely not ok to brag about it! I think bragging might be the greater ethical lapse here.
I suspect a lot of donors do it just to brag, or wouldn't do it if they couldn't brag about it. Certainly no one should donate if they wouldn't do it in a hypothetical world where it was impossible to brag about it - that makes motives very suspect.
The argument for bragging is that it might convince others to donate. It's unclear to me that this would be a good thing, but even if so, the harm to yourself and others from bragging far outweights any benefit from convincing others to donate.
How is bragging damaging to anyone? Let them brag, so that they may be encouraged to behave pro-socially on the expectation that they be granted bragging rights.
To be fair, I don't think Scott is bragging (he went off and did it without making a big announcement and fanfare, and only told us afterwards as much in part to explain why he hadn't been around as much).
Some people will brag, of course. But if they really went ahead and did it, then even if they want to be patted on the head for being supremely virtuous, they still come out on the debit side of the ledger. If they only talk about it but don't do it, or talk about why they would never do it not because they're squeamish or afraid of surgery etc. but because this is why it's more moral *not* to do it, then they do deserve a bucket of cold water over their head.
I frankly dont trust the medical field, from "protests from the right sort of people doesn't spread COVID", to the number one medical trade organization endorsing baby murder and the sterilization of mentally ill youth, to my constant contact with entitled Pre-Meds(I have been the lab instructor for several O-Chem classes), to the insane rules around around voluntary organ donation (tried to donate bone morrow; was denied for mild sleep apnea I'll literally be on a positive airway pressure during surgery) to historical grievances like doctors supporting of whatever "in" thing like coersive eugenics, to the fact that I still have to pay $150 a month for a simple stimulant prescription(not the medication which is another 300 dollars, when I can get it, but I won't blame doctors for that specific piece of DEA bullshit), despite taking this medication for almost 12 years, so I am very sympathetic to The Lone Ranger's argument, they obviously dont need organs because if they did they wouldnt have all these silly rules in place preventing people from donating.
Most of these things genuinely suck and I don't know how to solve them, but I think something's gone interestingly wrong in a possibly preventable way if you're paying $150 + $300 for stimulants. If you're in the US, the only stimulant I can imagine costing that much is Vyvanse, but it recently went off patent. Pharmacies are hoping you don't know this and trying to keep overcharging you, but you should be able to get it without insurance for ~$100/month at a local Rite-Aid or CVS if you use the GoodRx coupon, see https://www.goodrx.com/vyvanse . Sometimes pharmacies will refuse to honor the GoodRX coupons because "it's a controlled substance" - this is BS, but there's no good way around it, and you can solve this by going to a Costco or Walmart, where they usually have the fair price even without the coupon (although Costco sometimes saves stimulants for their members only during shortages, one of which is happening now). Let me know (scott@slatestarcodex.com) if there's some better way I can help with this, talking people through these processes is a big part of my job.
I also think your psychiatrist might be ripping you off if you're paying $150/month just to get the Vyvanse prescription. I would typically see a stable Vyvanse patient once every three months. A psych appointment ought to cost your insurance some amount, plus ~$45 copay. Unless you don't have insurance and are seeing a cash-only psychiatrist, that fee schedule doesn't make sense. So I think best practice would be for it to cost you $15/month (plus some extra amount for your insurance). Obviously none of this applies if there are no psychiatrists who take your insurance in your area or you don't have insurance, but it's probably semi-worth it to buy cheap ACA insurance just to take care of this problem, and "no psychiatrists have openings in your area" seems like a problem that shouldn't last 12 years. Let me know if you're in California and I will help you find someone less terrible than this; otherwise you're on your own. but now that there's telepsychiatry most people will find they have some options.
I don't think "they obviously don't need organs because if they did they wouldn't have all these rules in place" is a good argument. Sick people genuinely need organs, and medical bureaucrats have rules in place! There's no rule of incentives that says that if Group X really needs something, Group Y can't futz around making things hard for them for no reason!
Why should mentally ill people force their crappy genetics on someone else? They certainly will be horrible parents anyway, leaving their children or abusing them.
I hate my life and am mentally ill because of my useless father forcing me into this world (I grew up with a step father).
We need eugenics. Chris Langan has rightly defended it for decades. People don't care about their children anyway, killing or abandoning them. Were I not a Christian, I would kill myself immediately. In fact, were I not a Christian, I would forcibly sterilize the whole world. Who cares if you get sterilized, given how much sexual decadence exist today? Existing because your father and/or mother copulated with the n-th women or men just shows how meaningless our existence is and sexuality a curse by God which will not exist in Heaven, as Christ says Himself.
So stop this posturing please, ethics is a nonsense word for "morality" which has no basis outside religion, it cannot be defined by anyone but God.
I've been trying to work out why the original piece made me feel a little uneasy, when I rather admire what Scott and other donors do, as an act of straightforward selfless, kindness.....
And then it clicked. I think it's truly a fine thing to do. It is kind. Selfless. An act of grace. I'm not a christian but the christian tradition of valuing the gracious or even gratuitous act, a deed that may not be mandated by an ordinary moral code, is a very attractive concept.
EA at its worse sounds like a parody of utilitarianism. But its impulses are noble. Bernard Williams observed that utilitarianism thins out our moral language and thus thinking. Important distinct concepts such as love, honour, generosity, attention, grace (my partial list here, not his) get ignored or reduced, but these are central to long-standing notions of what it means to be a good person, of what it means to live well.
As I say, I admire the kidney donors. Perhaps Scott is too self-effacing to lay claim to the the virtues of what he has done but (to use another important word) it seems to me a noble thing.
Among the problems with arguments from optics is that how you look depends on who's looking. People who hate lawyers will look down on you for getting a law degree, but law offices will hire you for it. People who believe that murder is wrong will look down on you for it but it's a big bonus in the gang status ecosystem.
More relevantly for this example, some people will ALWAYS think you're weird or even evil for trying to change the status quo. Optimizing your optics for those people means abdicating all desire to make the world a better place. Choosing your altruism based on "actually doing good" means picking a form of optimism that signals seriousness and correct beliefs to a subset of altruists even if it means spurning many other causes.
Did no one comment from a markets standpoint? Legalizing the trade in live organs would solve a lot. Donors would get compensated for the risks (which don’t seem totally negligible and at least warrant further study) and their pain (just the word “catheter” is enough to ensure I would never do this except for a very well-behaved family member). As an added bonus, markets may even put a stop to the cringe moral preening of the donor class.
The last comment talked about the fear of a supposed organ mafia in Germany. At least in Brazil, this is a real fear many people have, especially after a real case happened (The Pavesi case) , which even makes them unlikely to allow post-mortum donation of their organs, so this might also occur in countries that share low trust of authorities.
Is there a breakdown on QALY for bone marrow donation vs. kidney donation? A friend of mine did a bone marrow donation, and he seemed to find it similarly transformative as an experience.
Fuck man, Scott did something quite amazingly altruistic that not even 0.1% of people actually do. Huge kudos to him, end of story. Altruism has been a thing since there is a humanity, and people have even found it even in birds and other critters. Why do people feel the need to create a huge controversy about it is beyond me. No one is asking *you* to do it, and I don't think anyone could actually argue that it's unethical. Scott gets the satisfaction of personally giving some lucky unknown a huge improvement in quality of life, and to exercise his 100% pure-American freedom. Win-win for all involved.
> You don’t kill your cattle on the full moon while chanting unless you’ve heard of other people doing that, but it might occur to someone to try to figure out how to do the most good even if they haven’t been brainwashed into trying. I’m more surprised that so few people find it to be an intuitively obvious goal.
I think this might be because most people (even if they won't agree to it plainly put) internalize "good" as a relative goal to themselves, their in-group, etc. An abstract goal of doing the most good implies that one can objectively measure a "good" that isn't your own self- and group-interest, since if you're working to the best goals you have for yourself already, that's just unremarkable.
>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?
It's the same reason some non-Vegans get mad at Vegans, and why smokers used to get mad at non-smokers.
If someone is doing something good hat you're not, it implicitly puts them above you in social hierarchy.
If a social norm comes into existence where lots and lots of people are doing a good thing that you're not doing and it seems normal to do that thing, you're suddenly actively being bad when you were just fine a moment ago.
People who don't intend to adhere to a newly forming social norm have an active interest in preventing that norm from forming, because it will be used to judge them in the future.
(Of course, this thought process is rarely explicit, and more commonly takes teh route of an ego-defense mechanism: 'People are trying to persuade everyone that doing X is good, but I'm a good person and I don't want to do X, X must be secretly bad for some reason and I should do the good thing and warn everyone against it')
I don't understand how Scott says he was there at the founding of EA - the founding of EA was with Peter Singer's famous 1972 essay "Famine, Affluence, and Morality" which was before Scott was born.
I assume publishing the book is not the same as starting a movement of people who change their lives according to the book.
For example, if tomorrow thousands of people start dressing like Harry Potter, the date of the "dressing like Harry Potter movement" would be tomorrow, not when the books were written.
When Singer wrote the essay, it didn't make people immediately pledge in mass to give 10% of their income to charity and research which charity is the optimal one. At first, for most people it was just another cool topic to discuss, without actually doing anything differently.
I hate writing critical comments other than in response to one or to rescue someone under critique.
Scott is the NICEST GUY. I never met him but I love him. I've recently had the good fortune to Zoom meet someone from this group and he's an amazing fellow. And most of what I've read from most people has been great too.
I have one bad experience with this group. It was early on in the hysteridemic and someone set up a Zoom or something. I was outdoors and recommending others live likewise and was mocked (behind my back of course, cowards gonna coward). But I was right and they were wrong.
So when I see a compadre's case getting stiffed in the main text I gotta come to his aid and point out that Scott missed the Lone Ranger but *shot the shit* out of his strawman.
Scott wasn't on that call and I'm certain that he would NOT have been like the rude (and oh so stupid) couple of snot-nosed know-nothings but he gave cover to The Scare and bears some of the responsibility for the impudent impunity with which his people acted to the one guy who was right.
Scott, with genuine respect, it seems that Lone Ranger doubts your medical evidence and you and the "rationalist community" generally when it comes to "socially good" medical matters.
I wasn't commenting then but I was reading, and you plus 90% of the people in this community were not only wrong but - ahead of the curve wrong - about Covid.
That jerkwad from the NYT who wanted to write a nice article about you and this community regarding how you "got covid right", did you a tremendous favor by totally ignoring your desire to not have your name revealed.
That killed the article that would have hung around your neck until the end of days.
I *LOVE* you, and I'm quite positive about nearly everyone in this community too but you were all Obviously And From The Start wrong-wrong-wrong and biased-biased-biased about Covid and there has never been a local "learning from our errors" in this space.
Or at least not one commensurate with the fact that this community was NOT uninfluential at that time.
This community and the many brainy indoor types that interact with it gave the kosher stamp of "smart serious men" approval to all the hysterics out there.
I don't know the numbers in kidney safety but dude has a point.
How many people here knowing lied or otherwise manipulated their words to get people to take the shot?
And that was waaaaayyyyyyyy down the line when everybody and their mother knew that "everybody would get Covid, it would kill the very medically compromised, and there's nothing we can do about any of it".
Oh, and that the shot was the placebo excuse for TPTB to call an official end to their hysterics without having to cede either fault or power.
I assume your numbers here are generally good so I won't dispute your claims about kidney donations, and in general I SUPPORT US ALL TAKING RESPONSIBILITY FOR EACH OTHER IN EVERY WAY.
But the shade he throws at your trustworthiness regarding matters medical that are within your understanding of "the moral good" isn't undeserved.
You're going to need to present evidence and links to specific disagreements if you want to be convincing to a rationalist. I would suggest either responding to the zvi's or putanumonit's take or a specific highly upvoted LW post
, because this is the type of drive by no (epistemic) effort disagreement that the community gets regularly, except this also happens in the opposite direction too.
Hi Scott - random IgA Nephropathy patient here. Your article made me cry in the good way. My life could depend on someone like you. Thanks for writing the article.
Reading the original essay really shocked me to my core. It feels so insane to give a part of your body to a random person you don't even know.
Why?
How about: maybe not everybody is equal? To me, Scott is worth more than a random person. He's even worth more than 10 random people. One more year of Scott will probably improve the world more than 100 years of random other people. So 1% chance of complications during surgery would not be worth 100% certainty of giving a person 40? (50? I don't know his age) more years to live.
I mean, isn't that the whole idea of EA? That you should think about how to most efficiently save people?
There's a lot of comments that are very bizzare to my own sense of morality. Maybe I'm just so Christian that I find it hard to comprehend people who assert that self-sacrifice is bad - not just not required, I understand that, but actually something that should be avoided and prevented? Sure, not everyone can be a saint, but apparently a lot more people agree with Randian objectivism than I would have thought?
To clarify, I'm pretty consequentialist when assessing right and wrong, but in order to have an actually usable defintion of morality I regard self-sacrifice for the sake of others as superegotory, not obligatory. Nobody is required to donate a kidney, I haven't done it so I'm in no position to criticise, but I still regard it as the right thing to do - in the same way that selling all you have to give it to the poor is the right thing to do, I just also haven't done that yet.
Anyway, I respect Scott more after this, and I'm glad he posted it because I think it may lead more people to do the same - not out of guilt, but out of a desire to better themselves/on-up other people, and isn't that what morality is all about?
I think the concern is that things stop being supererogatory when people actually start doing them regularly.
You not giving all your property to the poor is okay because no one around you actually does that. But imagine a world where dozen your friends already sold everything and donated the money to the poor... but you didn't. Wouldn't that make you seem like a bad Christian? I mean, if they all could do it, why can't *you*?
I can see why I might object to that, but that's only because I'm not a very good person, and I think that I might become a better person if people around me expected more of me. One of the ideas behind having an "EA Community" as opposed to just an EA Philosophy - or indeed, a Christian Community rather than just a Christian Philosophy - is that being part of the community places social pressure on you to do things like give away money (and I guess also kidneys now), it's a feature not a bug.
(As for whether this is the wrong reason to do this - I think people always have mixed motivations for even the most seemingly selfless acts, desire for social approval is a reasonable motivation as long as you're actually doing the right thing.)
Also, seem unlikely that regular kidney donations will ever be that common outside of a few weird subcultures, there are not that many people who need kidneys as a proportion of the population.
It seems that we have a somewhat paradoxical situation where good communities create more good but harm good people in the process, while bad communities create little good but allow good people to prosper.
Or maybe that's just a "valley of bad altruism". When few people are altruistic to the extreme, they have to sacrifice a lot. But if everyone shared the burden... for example, imagine if literally everyone on this planet was willing to donate a kidney -- only a few would actually have to. Scott would just sign up in some list of volunteers, but probably no one would ever call him, because there would be millions of other volunteers.
I found it puzzling that your original post there was a very strong argument that nobody paid any attention to, as far as I could tell:
> The procedure does increase your risk of kidney failure — but the average donor still has only a 1 to 2 percent chance of that happening. The vast majority of donors, 98 to 99 percent, don’t have kidney failure later on. And those who do get bumped up to the top of the waiting list due to their donation.
If properly fleshed out it has a potential to be an absolute killer: donating a kidney is like buying insurance against dying from kidney failure, so if you're concerned about it, and the numbers work out in your favor, you should, based on purely selfish logic.
But there's a problem, it looks like there are two kinds of people: some are deeply concerned about being Good, and donating a kidney provides them with a tangible evidence that they are in fact Good. This goes like a refrain through the original post and all the comments from people who donated.
The other kind of people don't feel this urge as strongly, and reading the above makes them feel that they are being shamed into it. Also they naturally suspect that deep down the altruistic people donate for status (and they could be partially right, even in case of people who only brag about being Provably Good in internet comments).
Of course most people are likely somewhere in the middle of this spectrum, but are pushed towards the ends by some sort of a cascade amplifying the initial kneejerk reaction, if your first thought happens to be oh shit here's a chance to do some good you will keep warming up to the idea, if it was that the donors appear awfully smug, you will invent reasons for why they have no moral authority.
But most interestingly this theory explains why being bumped to the top of the list of kidney receivers was soundly ignored. Because the pro-donation people, including yourself, are all of the first kind, and if it turns that donating a kidney is a *selfish* act then why, it means that your certificate of being a Good Person is not as good as you thought!
Therefore an *effective* way to convince people to donate kidneys might require writing two different posts aimed at these different audiences. One, investigating whether donating a kidney is a good insurance against dying while waiting for a kidney transplant and any other potential benefits you can find, and not mentioning anything about being a Good Person, and another, basically the one you did write, aimed at people who always wanted to donate for altruistic reasons but haven't realized that it's actually something they can go and get done.
"The multiphase abdominal CT used in kidney donation screening is 30 mSv"
For someone of your build, with modern scanners with automated tube current modulation, the dose would be closer to 10mSv. Here's a paper (It's 3-4 mSV per scan and 3 phases in the multiphase scan): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258803/
In the future with next generation photon counting scanners, radiation dose will go down another factor of 2-3 which should make this less of an issue.
tl;dr scott I think you got the science wrong, and are conveying the idea that a very damaging procedure isn't, and I think a lot of young people considering donation might be doing so without having thought through all the ethical implications and internal processes leading to this and potentially resulting from them.
I was thinking about my opposition to specifically monetary compensation for organ donation, and hit upon a solution which might actually be good - someone get the Catholic church or some other big religion to straight up confer sainthood onto organ donors. I think this is far less liable to abuse than paying people.
This seems to be the motive driving most EA altruistic donation, but that's secular, and a lot of people don't strongly identify with EA anyway. Enter: sainting.
Disadvantage: might make the average person who doesn't strongly identify with being/becoming a saint less likely to donate. I don't consider this a huge loss because I don't think they were likely donors to begin with.
Thinking about the fall-injury incentives thing from https://slatestarcodex.com/2016/11/10/book-review-house-of-god/ is it possible that somehow adjusting the basis on which medicaid and other government programs pay for dialysis would motivate existing medical providers to throw their weight behind reforms?
*Otherwise, I find it interesting that so many people feel protective of potential kidney donors and want to protect them from self-sacrifice... So what’s the psychological motive here?*
Fairness intuition. The median kind of person who would consider altruistic kidney donation is likely to be overly generous, overly giving and vulnerable to exploitation. No one likes to see a vulnerable or unusually generous person being exploited by free riders who’d never reciprocate.
Of course I don’t think Scott himself is particularly vulnerable to exploitation or manipulation; he thinks everything through too carefully for that. But if kidney donation were normalised, I expect a lot of overly kind people with low self esteem would pay the price. (The same people would be vulnerable in the event of euthanasia being normalised.) These people would be mostly female.
I’d never, ever do it myself for far too many reasons to list. But the reason I wouldn’t like it to be normalised is that it would inevitably result in a net transfer of health from females to males, and most women are already sacrificing their health for others in thousands of small and large ways that add up to a massive injustice.
Why should mentally ill people force their crappy genetics on someone else? They certainly will be horrible parents anyway, leaving their children or abusing them.
I hate my life and am mentally ill because of my useless father forcing me into this world (I grew up with a step father).
We need eugenics. Chris Langan has rightly defended it for decades. People don't care about their children anyway, killing or abandoning them. Were I not a Christian, I would kill myself immediately. In fact, were I not a Christian, I would forcibly sterilize the whole world. Who cares if you get sterilized, given how much sexual decadence exist today? Existing because your father and/or mother copulated with the n-th women or men just shows how meaningless our existence is and sexuality a curse by God which will not exist in Heaven, as Christ says Himself.
So stop this posturing please, ethics is a nonsense word for "morality" which has no basis outside religion, it cannot be defined by anyone but God.
>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!
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.)
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.
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.
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.
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.
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.
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.
This exactly - the regret seems terrible to me. I'm very worried about the regret.
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)?
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.
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?
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.
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).
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.
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
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.
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."
>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.
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.
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.
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.
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.
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.
Not from a donation perspective, from the perspective of her dispute with the other writer?
Yeah, how are you on her side? She seemed like a horrible person and the other writer didn't do anything wrong.
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.
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.
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.
'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.
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."
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
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.
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.
Better whack himself in the head with a cactus instead?
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.
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.
Okay, maybe some of you are just in favor of people suffering and dying from kidney disease ¯\_(ツ)_/¯
No, but we don't think donating is right.
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...
What do you mean about taboos and covid?
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.
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.
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;)
There's literally never going to be social pressure to donate a kidney. That's not really a concern.
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)
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.
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...
"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.
I have hereby been educated! Thank you, my heuristic that things in my body are there for a reason is now reinforced even further.
I feel like most of the body's 'mystery' organs/tissues are immune related. Thymus, bone marrow, spleen, lymph and lymph nodes, tonsils, omentum.
Now to figure out what the gall bladder is for...
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.
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.
Immune cell production - you can survive it’s removal as an adult but it does weaken your immune system.
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.
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?
Thanks for the correction. It's been a few years since grad school.
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.
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.
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.
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.
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).
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.
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?
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!
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.
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.
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.
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."
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
I approve of this solution to the trolley problem and am going to steal it
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).
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.
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.
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.
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).
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.
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).
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?
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.
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.
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.
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.
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.
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.
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.
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.
I'm a lot more concerned about the donor's situation than what happens to the recipient!
But *why*??? I assume you are speaking as a moral matter not based on some kind of professional responsibility.
because hurting your own future is worse than hurting someone else's
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.
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.
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.
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.
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.
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.
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
liver, spleen, gallbladder, stomach, intestines...lots of abdominal organs aren't bilaterally symmetric.
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
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).
- 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.
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)
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?
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).
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.
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).
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
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.
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.
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.
Do you have any evidence for this claim? Has this ever happened to any doctor?
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.
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.
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.
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.
Not donating results in worse harm to the prospective recipient.
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.
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.
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!
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?
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.
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".
I did have similar thoughts when I donated. Its really a solid benefit of the whole thing
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.)
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"
GPT isn't any kind of authority and is unlikely to be accurate on these things. Its answers are full of hallucinations.
This is definitely true
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!"
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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
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.
> "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.
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.
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.
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.
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.)
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.
>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!
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.
I expand upon the puzzle further here:
https://rychappell.substack.com/p/anti-altruistic-paternalism
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.
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.
I honestly disagree that kidney-donation is an "EA" action at all.
in the sense that it's not altruistic? or in the sense that it's not effective compared to other things?
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.
Donating a kidney to a complete stranger, specific beneficiary to be determined by various doctors you'll never meet, doesn't seem very local.
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.
>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.
> 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.
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.
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."
Don't should on yourself. ;D
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.
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.
because it's too costly. It's too self-sacrificial. A person with a healthy sense of self-regard would not do it.
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.
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".
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
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.
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!
> 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.
"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.
> I cannot understand opposition to a responsible farm.
99% of people who say this are still getting their food from factory farms.
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
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.
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.
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.
>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.
"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."
You might be bolstering Michael Watts's point with this.
Sorry I don’t see how so?
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.
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.
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.
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.
It's always fun to spot The Worst Argument In The World in the wild.
Is there a central example of "cultic ritual self-mutilation" from which this substantially differs?
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.
How? I don't see it.
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.
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?
My understanding is that it used to be correct, but now it’s wrong. But I’m not a doctor.
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
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
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.
Please see point 1 at https://slatestarcodex.com/2019/07/04/some-clarifications-on-rationalist-blogging/
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.
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.
So, if I disagree with the moralization framework should I be more annoyed that this is going to influence a bunch of people to do a thing? (I don't actually care, and I think the world would be slightly better if a bunch of people donated kidneys).
But... I disagree with Memeplex Virus Spreaders spreading their meme viruses too aggressively. I want to reduce the spread of bad meme viruses (idpol/anti-idpol craziness) and I'm okay if that makes it harder to spread good meme viruses.
The first propagators of a meme virus are probably doing a good job/know what they're talking about/have a good idea. But eventually every memeplex will devolve in to vegans who look doughy and greasy because they only eat Oreos and complain about people eating honey.
What's the nephrectomical equivalent of vegans who only eat Oreos?
And you really should change "honey" to "semen."
The Like button isn't enabled, so consider this my 👍️
aww thanks! But I seriously wanted to know what you thought the kidney donation memeplex would devolve into!
I don't have a super quippy version, but perhaps it is a young person who never really did anything with their life and reads a couple of un-challenged blog posts about how easy it is to donate a kidney, so they sign up and go through with it. A bunch of years later they decide to get really fit and start training really hard and it turns out that maybe 85% kidney capacity just ain't good enough, and also the recipient ended up dying or rejecting their kidney and they didn't sign up for this shit. It's easy to opt in to reduced bodily health capacities when you're young and your life meter is at 100% but I've been really surprised how things start to degrade for me and my friends as we hit 40.
I love when normal, average dudes sign up for the most memeplexy versions of Twitter MeToo Feminism and then get bit by that one bad date they had and get tossed from their social circle. I imagine a bunch of living donors being similarly enthusiastic about the memes they were fed until it turns out that maybe they really should have kept that organ that they evolved to have two of because they weren't the invincible super humans they thought they were in their 20s when EA was a fad.
I'll take another shot at this after scrolling down 10cm to see more replies in this sub-thread. 10cm below your comment, people discussing how influential Scott vs Dylan (someone I haven't heard of) are and how one guy convinced 8 people to donate their kidneys through podcasts.
Now I'm picturing a bunch of in-group status jockeying between vanlife fitness influencers who think they're invincible because flavoured protein water brands pay their bills. The best way to out-signal someone is to donate your kidney and periodically lobes of your liver.
I used to follow a few vanlife people and for some reason, they always end up killing themselves, quitting the vanlife in disgust/exhaustion, or accidentally run over their dog because they want to get the perfect shot. How likely is it that influencers have it all figured out? Pretty low, just like the rest of us, just like kidney/liver donation influencers.
I just subscribed to your newsletter.
Aren't there only like 200 stranger donors a year, per Scott's essay? Even if Matthews accounted for *every single one*, which seems absurd, he would barely be responsible for a thousand. If you're suggesting he influenced more family and chain donation, though, my estimate is moot.
I would suspect Scott is more influential than Dylan, though. Dylan might have a larger readership, but a low-quality one (that's partially anti-Vox snark, but a more general statement regarding the casual nature of "news" readership); Scott's is more dedicated and prone to being influenced by him.
My estimate is informed by my own story. I am one of Dylan's downstream donors who was influenced by him. And I, by myself, have influenced at minimum 8-10 people to donate through podcasts, AMAs, and other channels. I look at my own success convincing people and think that Dylan must have been much bigger.
"You don’t kill your cattle on the full moon while chanting unless you’ve heard of other people doing that, but it might occur to someone to try to figure out how to do the most good even if they haven’t been brainwashed into trying. I’m more surprised that so few people find it to be an intuitively obvious goal."
I'm sorry. I may be missing something, but I just don't understand how Scott can keep describing Effective Altruism like this ("do the most good"), and how so few comments seem to really challenge this head-on, when Scott (along with this community) was the one who popularised the most lucid description of this exact fallacy: the motte-and-bailey.
Doing the most good means, in practice, saying hypothetical future uploaded "people" are as important as real people, with people lives and real suffering, who actually exist right now. It means actively supporting the destruction of "unwanted" human life on an unimaginable scale to slightly benefit the majority. Or less horrifically, it means getting the best outcomes *at the expense of every other moral value*: e.g. embracing the widely-recognised vice of greed in "earning to give".
HOW is calling these things "doing the most good" ANY different from calling feminist positions (eliminating due process, cryshing freedom of speech) "believing that women are people"? That was the context Scott originally introduced the concept of motte-bailey, and yet it never gets applied to EA. The only possible defence I can imagine is that the above EA positions are not very common. Is this the case? And if not, am I missing some reason this whole ideology isn't as dishonest and cult-like as every other one?
> *at the expense of every other moral value
I believe the standard response is "shut up and calculate."
"It means actively supporting the destruction of "unwanted" human life on an unimaginable scale to slightly benefit the majority."
That's an issue with average utilitarianism, not EA.
Hmm it sounds like you have a biased/warped view of EA, are you perhaps confusing it with the LessWrong community (which is much more focused on AI)? The strongest associations I have for EA are using 10% of one's income to buy mosquito nets in Africa and eating fewer chickens.
Longtermism is something like 40% of EA spending, last I checked. Not sure how much the collapse of FTX affected that though.
I think longtermism gets something like 80% of EA *attention*, especially external like MacAskill's big book tour last year, while the bednets chug along quietly in the background, but that's not as easily measured. If you've been watching them a long time you still think "bednets," newcomers think "digital people of the far future."
OK, I haven't paid much attention to McAskill and longtermism. I admit I thought it was more about climate change and avoiding X-risks (also including AI, sure) than mind uploading.
Where did you get the 40% number? Looking at general grants from 2022, I'm seeing about 25-30%
https://forum.effectivealtruism.org/posts/ZbaDmowkXbTBsxvHn/historical-ea-funding-data
(From eyeballing the chart at the top)
And the latest EA survey from 2020 says around 18% (Ctrl f 18.2 to find relevant section)
https://forum.effectivealtruism.org/posts/nb6tQ5MRRpXydJQFq/ea-survey-2020-series-donation-data
Am I missing the 2022 data? Because traditionally X risk causes lag far behind global poverty.
I appreciate the question! I remember it was a nice little bar-chart, most likely on EA forum or The Zvi's substack... but I can't find it currently. Alas.
Looking at this (https://forum.effectivealtruism.org/posts/fDLmDe8HQq2ueCxk6/ftx-future-fund-and-longtermism) (aged like... maybe not quite milk, but at least soft cheese) and this (https://forum.effectivealtruism.org/posts/vqPy7TkBbzrAkxCf7/updates-to-the-flow-of-funding-in-ea-movement-building-post) I might have been mixing up "movement-building funding" with total funding (but longtermism movement building seems to be much higher than 40%?), or the bar-chart I'm trying to remember was very much a brief snapshot during 2022 and most of that money went poof, so 25%ish seems closer to accurate outside that bubble. Thank you!
I stand by my old-timer vs newcomer perception difference, though.
Your perception is probably correct, however it's quite funny imo because there was an EA meme around 2018 where it was said that recruiters lure in newcomers with global poverty and bednets, then you proverbially pull the rug out from under them because of all the x risk discussion afterwards convincing them towards Ai!
The way I see it, the foundation of EA is literally 'do the most good', and to advance a cause within EA you need to make arguments to that effect. But there are inevitably going to be serious disagreements at both the philosophical (what is 'good', how do we measure it) and empirical (what are the likely effects of our actions) levels. So two people can legitimately describe themselves as EAs while pursuing very different, even actively conflicting, goals -- or while pursuing the same basic goal in conflicting ways.
An intellectually serious EA, while they might hold that 'do the most good' -> 'take actions X Y Z', won't actually conflate the concept 'do the most good' with the concept 'take actions X Y Z'. So you'll be able to have a conversation with them about why they hold the specific positions they hold, what assumptions their most important decisions are based on, how they would behave differently if they were convinced of arguments A and B, how *you* should behave differently from them given disagreements G and H, and so on.
I've tried to answer this at https://www.astralcodexten.com/p/effective-altruism-as-a-tower-of . I do agree that the positions you call "the above positions" aren't very common in the movement (and I can't even figure out what you mean by "destruction of unwanted human life").
I also think "embracing the vice of greed" is a mixing up of levels, sort of like if there was someone with a metabolic condition that required them to eat more than usual and you accused them of "embracing the vice of gluttony". I think of all of these things as heuristics in the same sense as in the response to Stephen at the top of this post.
Thanks for replying.
Ever since I saw that Tower of Assumptions post (which was some time after it was posted, so the comments were dead), I've struggled to see how it isn't a general counter-argument against every motte-and-bailey criticism. Surely you can apply it to feminism ("women have the same value as men" at the bottom and "rape accusations should be believed without question" higher up), to Christianity ("there is beauty and order in the universe" at the bottom and "homosexuality is wrong because God says so" higher up), and so on. Allowing this defence only to Effective Altruism is an Isolated Demand for Rigour, surely?
And if it *does* apply as a defence to all these other movements, well I have problems with the idea of a tower of assumptions that I can elaborate on but basically boil down to the same point you were making in Social Justice And Words Words Words. Otherwise, is the only difference for you the frequency with which the extreme positions occur? So if somewhat less (but still a decent number of) feminists/Christians/etc believed the objectionable thing, the motte-and-bailey objection wouldn't hold? How do you decide the proportion of a movement's members that must believe x before it's fair to ascribe x to the movement as a whole?
" and I can't even figure out what you mean by "destruction of unwanted human life" "
Mostly, destruction of unborn life. By promoting abortion (not just as something that should be allowed, which is questionable enough, but that should be actively promoted and enabled). By promoting, especially, abortion and even infanticide of babies with some condition (e.g. Down's Syndrome) that doesn't make life not worth living but is inconvenient for society. By advocating polygenic selection without talking at all about whether it would lead to destruction of embryos, whether it would increase implantation failures, and so on. It may well be that there are morally satisfactory answers to these questions. What I object to is the fact that, in the discussions I have seen, the questions are basically not raised at all!
To your last paragraph, that seems a straightforwardly extreme-consequentialist response: not just that consequences matter, but that ALL other values ultimately reduce to consequences. Which is exactly my point, that EA claims to be about "all else being equal, do the thing with the best outcomes" when it's really about "do the thing with the best outcomes, all other considerations be damned". Honest consequentialism is fine; I don't agree with it, but I respect it. What I object to is a movement calling itself Effective Altruism instead of Consequentialist Altruism. The way they present themselves, and certainly the way most people are going to perceive them, is as much less than consequentialist ideologues, which (judging from things like "earning to give") they are.
EDIT: Just to elaborate on the basis for the "embracing the vice of greed" objection, it's this: if you participate in a system where you exploit people, gather wealth in dishonourable ways, are you more culpable for these things happening than you would be if someone else did those things instead of you? The consequentialist says no, it's the same result either way (people are exploited for money) but if you use that money for good you're actually making things better. The non-consequentialist says yes, the fact that *you* are doing the exploiting makes you personally culpable in a way you wouldn't be if you refused to take that job and someone else took it and did the exact same thing. This is more clearly expressed in Bernard Williams' thought experiment "George the Chemist", and it seems very widely intuitive and requiring substantial argument to refute.
If culpability in dishonorable wealth-accumulation is something to avoid, isn't it also undesirable to foreseeably condemn someone else to that fate? Perhaps not to exactly the same extent, but given that you apparently believe some responsibility for other peoples' moral decisions exists, sufficient to motivate an attempt to talk EAists into making better moral decisions, the remaining question is only a matter of degree.
>how so few comments seem to really challenge this head-on
Many commenters have probably learned that EA is one of those topics you can't really critique to Scott, except on very narrow grounds and/or if you've proved your greater sainthood already. Taking the big critique like that is generally a waste of time.
Why is that?
> I am proud to be an American, where I have freedom of speech, freedom to take melatonin whenever I want, and freedom to donate a kidney. You’ve got to keep exercising rights if you want to keep them, and I’m proud my country has defeated the evil bioethicists on this one and kept this option open for me. (The UK, Canada, Australia, and I think most other European countries also allow altruistic donation; Germany is a rare holdout here. Still, the US was one of the first, and I’m still proud of it.)
I don't think we can really claim to have defeated the evil bioethicists here; selling kidneys is still illegal. (May also be due to the evil pro-poverty lobby.)
Iran is the true defeater of the Great Satan.
OTOH, there are people who do want an international organ market, with poor people as the donors.
"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?"
It's selfish. People don't want to donate a kidney because that's a lot of work, so it's in their self-interest to avoid the normalization of kidney donation, lest they find themselves in a world where every annoying charity worker is badgering them for internal organs.
Yes, I think it's a huge part of the puzzle.
It's one thing to acknowledge that kidney donation is "a commendable act of a saint" and then keep not doing it, because of course you are not a saint, you are just a regular person. But when kidney donation is just a regular thing you can do, moreover, a rational thing to do, if you value the lives of other humans, now you immediately feel social pressure.
When "a lot of work" means taking a month off work, potentially flying across the country and spending a week in a hospital, adding some statistically-small-but-meaningful risk of chronic pain and death to your life, potentially having to eat a kidney-safe diet, etc, "selfish" doesn't look as bad as tends to colloquially.
Refusing on their own account I agree with you, but once they start trying to persuade other people not to just so it's a little easier for them to refuse it starts to look a little worse.
Yeah, it's more like having a healthy regard for self.
I think a person with a health regard for self would not donate a kidney. That's why I'm against it.
I would say it's "having a healthy regard for self" which is not the same as selfish.
> I’m going to do the jerk thing here and accuse Stephen of being wrong about his own internal processes.
No, Scott, you're not being a jerk. You're a very nice guy. But you're also wrong here.
> How did Stephen come to value bodily integrity... “Value bodily integrity” is a useful heuristic for avoiding bad things.
"Value bodily integrity" isn't a heuristic for me for avoiding other bad things. Rather, bodily integrity is itself a good, among others. In computer science jargon, you might say it's a "primitive."
> I predict he would also consider vaccination, pacemaker-implantation, and contact lenses to be valid exceptions.
No, I wouldn't consider these exceptions at all (although I approve of all of them). That's because they simply don't violate bodily integrity in the relevant sense, as does removing an organ. Rather, they improve health or function in other ways (i.e., without violating bodily integrity).
> How come I, an outsider without access to his moral reasoning, can predict what exceptions he’ll allow?
As noted, you can't. (While you correctly predicted that I would approve of those things, you mistakenly took them to be exceptions to avoidance of violating bodily integrity.)
> Probably because he allows as an exception anywhere benefits > costs.
No, I would allow exceptions where I'm aiming to serve a greater good, such as "restore my bodily function when there is no better way." I know this may sound like the same thing to you, but it's not, and the attempt to recast it into cost/benefit terms will actually change it into something different (that produces different answers to some questions). Key point: I consider the goods in question to be nonfungible, not fungible utility.
> I propose he’s using it as a heuristic for what he really wants, which is something like trying to stay healthy and safe while balancing that out with satisfying his other values.
• Again, not a heuristic at all.
• Health is certainly a related though distinct good.
• Again, vaccines simply don't violate bodily integrity, so not even an exception.
> kidney donation still emotionally feels really scary and not beneficial to Stephen, he prefers not to do it, he can’t come up with a great utilitarian case for not doing it, so he falls back on a semi-crystallized heuristic
I don't find kidney donation emotionally really scary. I'm actually pretty adventuresome in terms of medical interventions (just not those that violate bodily integrity lol). I don't even look for utilitarian cases for or against things, because I don't think that's what makes them good or bad. I don't much rely on heuristics for this sort of thing.
How does a paper cut violate it but a vaccine doesn't? Both break skin and blood vessels.
I think I (and probably also Scott) don't get what you mean by bodily integrity, in that case.
There is a factor of magnitude that comes into play when judging whether to endure harm to one good in pursuit of another. In both the case of a paper cut and a vaccine, the skin breakage and damage to blood vessels are minute. Unlike a paper cut, vaccine serves another good (improvement to the immune system). I said that a vaccine isn't even an exception to "avoid harm to bodily integrity." If one wants to be pedantic, I suppose one could instead say that it is a trivial exception, warranted by the good served.
So a vaccine isn't actually an exception, it's a cost-benefit analysis, like Scott said.
I don't analyze it as an exception. I analyze as an trade-off of the harm to bodily integrity for the sake of the good of health. In this particular case, the trade-off is easy because the harm to bodily integrity in trivial, and the increase in health is therefore more significant.
I don't analyze this in terms of cost-benefit, because that implies a common, fungible dimension of utility in which costs and benefits could be measured and weighed.
So I think that's the same as what Scott predicted: you do see it as a (very minor) violation of BI, but one that you consider worthwhile because the good outweighs the harm. Like most people, who don't have a "bodily integrity" axiom.
Did Scott correctly predict that I approve of vaccines? Yes.
Do I agree with or think in terms of Scott's analysis? No.
What’s the difference between a trade-off and a cost-benefit analysis?
It makes sense that you’re willing to accept small harms to BI for great benefits, and if the benefit was great enough I assume you would accept even great harms to BI (e.g., removing a cancerous or gangrenous appendage to save your life). Scott also is willing to accept harm to BI (the kidney) to save a life, but the life is someone else’s. Why is that a fundamentally different calculation?
The difference is between fungible utility and nonfungible goods.
Very loose analogy: Imagine you are a collector of Nonfungible Tokens representing trading cards for a game. The rules of this game state that the NFTs cannot be bought or sold, only traded. You might have a discussion with a fellow collector and decide to trade your card A for his card B. This could be for any number of complicated, possibly difficult-to-express reasons (say, regarding how A and B functionally relate to the others cards in your collection). But the reason is not because A has a market value of $3 and B has a market value of $5, anything else reducible to something similar.
I claim that this is meaningfully different from buying or selling things in dollars, bitcoin, or any other fungible token, or trading things chiefly on the basis of such.
...Honestly, at this point I'm just confused what you even mean by "bodily integrity." If you don't want to donate a kidney because you don't want to risk making yourself less healthy, you can just say that. We're not going to judge.
Reading through everything again, I think this is all just a misunderstanding. When people hear "bodily integrity," they assume you're talking about some body purity thing (refusing to modify your body in any way with treatments, prosthetics, etc), but it seems that you just don't want to do anything that would hurt your body, which is perfectly fine. I still don't understand what that has to do with morality though, especially when you say that restoring bodily function serves a "greater good," when the entire situation only involves you. When people talk about morality, it's generally about how you interact with others and how your actions affect them.
> I still don't understand what that has to do with morality though
For me, it's just the opposite. I recognize no sense of "morality" whatsoever apart from promoting particular goods and avoiding harm to particular goods.
Regarding the "how is this not like a cult getting people's money" comment, I saw people point out that the kidney is not going to the cult, but to strangers. But I didn't see anyone point out that religious movements that persuade people to devote a lot of their money and time *to good-faith charitable causes* (i.e. benefiting strangers, not the religious leaders) rather than to self-serving cult leaders aren't vilified; they're generally praised. So it seems like the commenter's argument is "if we don't like it when people are persuaded to do harmful things, why should we like it when they're persuaded to do good things?"
> I think a lot of people have a heuristic of something like “if you’re making a profit, you’re probably screwing someone over”.
There's a term for this: https://en.wikipedia.org/wiki/Limited_good
(Also a lot of people will straight-up openly assert this. I don't know how they explain why they themselves engage in trade when they are apparently losing from it.)
Even if trade is mutually beneficial, the "surplus benefit", or whatever the technical term, can be arbitrarily distributed between the traders. If you believe that any distribution other than equal means screwing somebody over, then the vast majority of transactions do just that, due to various power, information etc. differentials.
The crucial mistake here, of the "perfect is the enemy of good" variety, is imagining it's easy to change the distribution without losing value in the process.
+1. The technical term is "gains from trade", btw.
I think in this context "surplus" is a little closer to what's meant, in the context of either consumer surplus or supplier surplus.
Yes, sorry, I got a bit sloppy there. A lot goes into the interpretation of "screwing someone over". A liberal would interpret it as "making someone worse off", whereas a leftist would interpret it differently.
That said, there are a number of people who will straight-up assert zero-sum-ness, which is much less ambiguous and almost certainly incompatible with their own actions.
It's not just random people that have this viewpoint, even illustrious philosophers fall for this 'Naïve Cynicism' and conclude that "Things shouldn't be allowed unless no one actually benefits from it -- since if you're benefiting from it, you must be screwing someone else over." See https://www.econlib.org/library/Columns/y2020/Muellerjustprice.html & https://www.metmuseum.org/toah/hd/schg/hd_schg.htm for example -- it's Aristotle on "Just Prices", Aquinas condemning "profiteering", Confucian philosophers deriding merchants as leeches and parasites below even, *gasp*, the artisans...
(Though I suppose some would argue that illustrious philosophers are *especially* prone to believing that merchants must secretly be leeches, whether out of jealousy or sheer confusion over how uneducated dolts can show them up and accrue more power and influence than any would-be philosopher king... the easiest way to explain it all away is that it must all secretly be a scam.)
Incidentally, I don't have this heuristic and didn't 100% follow how Scott got there from my post.
An anecdote in favor of transplant evaluation people: I was recently a stem cell donor for my dad's cancer treatment. I had to talk to a social worker, whose job was to tick a bunch of boxes saying I was sane enough to consent to the procedure, and wasn't being coerced.
She was as upfront as she could possibly be, short of grossly breaching professional norms like, that her job was basically to make sure I wasn't part of the tiny minority of people who are actually being blackmailed into donating by their families, and that aside from that our conversation was basically useless. When she asked me "can you tell me in your own words why you're donating" and I looked at her like she was an idiot and said "because I don't want my dad to die of cancer" she chuckled and gave me a "yeah I get that a lot" smirk. She also gave me some off-label advice on how to avoid feeling like crap after the donations ("the doctors will just tell you to hydrate, but those electrolyte sports drinks are really where it's at, chug a bunch of Gatorade the day before and right after the procedure and you won't even notice the side effects"). I can't say whether her advice was actually good, but I followed it and I felt fine.
None of this means you shouldn't lie to these people, because the consequences of telling the truth if you happen to get an evil one are terrible. But there is at least one of them who is a sane human being.
Thanks for providing this useful counterexample.
"the tiny minority of people who are actually being blackmailed into donating by their families"
I'll tell you the practice that made me see red at the time it was being discussed; it stuck in my craw and I've never been able to swallow it.
Saviour siblings.
Wikipedia is mealy-mouthed about the practice; if you go by that article, it's just umbilical cord stem cells is all:
https://en.wikipedia.org/wiki/Savior_sibling
"Multiple embryos are created and preimplantation genetic diagnosis is used to detect and select ones that are free of a genetic disorder and that are also a HLA match for an existing sibling who requires a transplant. Upon birth, umbilical cord blood is taken and used for hematopoietic stem cell transplantation."
In fact, the definition is a *little* broader than that:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220490/
"A Savior Sibling is a child who is born to provide an organ, bone marrow or cell transplant, to a sibling that is affected with a fatal disease."
However, we are reassured that in general, "only" blood or bone marrow transplants occur.
How young for bone marrow transplants? How about somewhere around 1.5 years of age as a donor?
https://www.theswaddle.com/an-indian-baby-savior-sibling-just-gave-her-brother-bone-marrow-but-is-it-ethical
"“We had to wait for the baby to grow. She had to weigh 10 kg before we could draw bone marrow,” Deepa Trivedi, program director of Sankalp Bone Marrow Unit in Ahmedabad, told The Hindu. It’s been approximately seven months since the transplant, and the older sibling has not needed any more blood transfusions, indicating he has been cured of his thalassemia, his doctors announced."
If the baby needed to be a minimum of 10kg, for a female infant that is around 17 months old:
https://www.babycenter.com/baby/baby-development/average-weight-and-growth-chart-for-babies-toddlers-and-beyo_10357633
For a similar case in the UK, it was an 18 month old boy who donated bone marrow to his older sibling:
https://www.bbc.com/news/health-12055034
Suppose, though, the older child needs some other kind of donation as they get older? How resistant can the younger child be to familial pressure about "do you want your sibling to die?" Apparently in the UK, you can't create 'saviour siblings' if the intent is for whole organ transplant, and a donor has to be a minimum of 16 years of age. But it is feasible that a sixteen year old can come under pressure to be the 'saviour' once again, even if they don't want to do so.
https://eusci.org.uk/2022/06/07/saviour-siblings-draw-the-line-at-organ-donation/
Donating bone marrow (stem cells, specifically) is an extremely low risk procedure. Your bone marrow is a renewable resource. As long as you want and take care of the kid, how is that evil?
You tell me how an 18 month old infant can meaningfully consent to a surgical procedure. I know parents make medical decisions for their kids all the time, but if a grown adult is going "No, I don't like the risks of bone marrow donation" why expect that a child who may be just about saying their first words can agree? We're not simply talking about stem cells, but actual marrow of the bones:
"Bone marrow donation is one of two methods of collecting blood forming cells for bone marrow transplants. Bone marrow donation is a surgical procedure that takes place in a hospital operating room. Doctors use needles to withdraw liquid marrow (where the body’s blood-forming cells are made) from both sides of the back of your pelvic bone. You will be given anesthesia and feel no pain during the donation. After donation, your liquid marrow is transported to the patient’s location for transplant."
The risks may be low, but it's a surgical procedure which always involves some risks, and for a very young child such as this, I think the risk from general anaethesia is likely to be higher.
And I think this little nugget demonstrates the kind of 'nudging' that the Evil Social Workers with their Checklists are trying to prevent:
https://www.ama-assn.org/delivering-care/ethics/asking-children-donate-bone-marrow-5-must-meet-conditions
"Not donating also has risks. For example, a sibling in need of an organ might be unlikely to receive a transplant otherwise. A child’s refusal to donate might, therefore, reasonably mean imminent death of the sibling in need. Besides being a source of guilt and remorse, refusing to be a living donor for a sibling in need could undermine stability and support provided by parents."
Again, even for an adult - plying emotional blackmail like "but your family member will likely die and then you'll be wracked with guilt and remorse, and your surviving family members may not love you anymore" is heady stuff, now turn that up to eleven for a child who is old enough to have some understanding of what is going on, but not old enough to be able to stand up to that kind of pressure. "Mom and Dad will hate me if I don't do this" is not a good enough reason.
(edited because I pressed post accidentally before I was finished typing)
I am a young adult blood and marrow cancer survivor. Taking actual bone marrow is indeed a very painful process. I have had several bone marrow biopsies where a surgical drill was used to collect a core sample from my bones while I was still awake. It is not pleasant, it is painful and distressing enough to be traumatic and I would not wish it on anyone.
But! Even though we still call bone marrow transplants such, they're mostly conducted with just stem cells nowadays. Most modern donors only have to take an injectable drug called colony growth stimulating factor for a few days, which stimulates their body to make extra stem cells of the kind that turn into your various blood cells, since blood cells don't reproduce on their own and instead your blood supply relies on your bone marrow continually pumping out new precursor cells. After that your blood is ran through a filter that's sorta like a one time dialysis thing, except it's collecting excess stem cells instead of toxins. This requires an IV which can be irritating. It's not a surgical procedure and it's outpatient. I have been on colony growth stimulating factor a dozen times, in a minority of people it causes pretty bad bone pain for a few days but it is relieved by taking Claritin, for some reason nobody is sure about. Very few other notable side effects that I can remember. Also sometimes the nurses forget to warm it up before injecting it and the injection site hurts momentarily, as is typical when you have cold fluid injected into your muscle.
Does that change your mind at all?
Does it change my mind? On the risks, yes. On whether very young children should, in effect, be used as spare parts generators - no. I realise that there are safeguards in place around that, and I'm glad, but I still think even taking stem cells from 18 month olds is dubious. It's to save a dying sibling, and the infant probably won't remember much if anything about the procedure, but it's still a very big decision to make on behalf of someone to whom you owe a duty of care.
I admit, I'm not able to generate a universal rule out of what is unease on my part, it's just my own personal view of the matter.
"And Stephen admits there are “a thousand and one exceptions”. Later in the thread, he lists some of these: blood donations, haircuts, laser eye surgery. I predict he would also consider vaccination, pacemaker-implantation, and contact lenses to be valid exceptions."
I don't think it's that hard to square the circle on "exceptions" to the notion of bodily integrity. The examples given would violate bodily integrity only if you define that in terms of the structural composition of the body (i.e. keeping the body as it is, without additions or removals), perhaps out a sense of purity or a belief in the sanctity of the form. But if instead you view bodily integrity as conditional on the functioning of the body, then the exceptions stop being exceptions and become legitimate extensions of the idea. Blood donations, vaccinations, haircuts, pacemakers, and so on are fine because they either improve bodily functioning or don't negatively impact it in any permanent manner. Donating an organ, in contrast, does.
Good point, actually ”bodily integrity” was just a red herring, leading to unnecessary discussion, and what he is against is damaging bodily function. Although that still leaves the question of stuff like vasectomies.
Is blood really so categorically different? They are functional cells of your body. You will have lower haemoglobin levels and must be at least somewhat at more risk of serious blood loss or other complications in the case of an injury in the next few weeks after donation.
The main difference morally seems to be that the risk from blood donation's impact is (as far as we know) temporary, but I'm not convinced that's a tidy distinction to base a moral principle on. It seems like a pretty smooth slide in terms of from hair donation to plasma donation, whole blood donation, bone marrow donation, liver donation, kidney donation.
I don't see how it's a smooth slide at all. Your blood, at least when taken in the context of a blood donation, is easily and quickly replaced. Your kidney never will be. Removing the latter affects the integrated functioning of the body in a categorically different way than the former. If you value bodily integrity (in the way defined above) then the two are not comparable. If kidneys grew back then this would be a different discussion.
If you're arguing against a smooth slide existing, shouldn't you be picking two things that are adjacent to each other on that slide, and explaining how there is a discontinuity there?
To stretch the metaphor, all you are saying is that there is a categorical difference between being on top of a slide and down a slide.
To make this a bit more concrete: you say "If kidneys grew back then this would be a different discussion". Well, livers grow back, though it appears that it can take years to regrow to the pre-operative size and we lack the data to know if this always occurs. So where does that sit?
I see a typo on something I said, I meant chimeric not chiral 😅
Thanks for highlighting my comment. My last name is Böttger not Bottger, with an o Umlaut. Not that it really matters, since you wrote it correctly in the Book Review Contest 2023 Winners post.
> I find it interesting that so many people feel protective of potential kidney donors and want to protect them from self-sacrifice.
My guess on the underlying instincts: the person you're talking to matters more than someone who will never know you existed. So you want to talk like you're protecting their interests. And the people being talked to were potential donors; potential recipients weren't on the radar.
I know this doesn't bring much to the discussion, but the phrase "Opt-Out Organ Donation" just makes me feel such an instinctive fear like I've never felt about any other string of words. I imagine that I've spent way too much time around the privacy protection and free software side of the internet where the words "opt-out" 99% of the time have a very bad to Orwellian bad connotation (as in "oops, you forgot to opt-out of Google Maps tracking your precise location 24/7 and selling it to advertisers/law enforcement/anybody else" bad), but still.
I am tempted to get a "no organ donation" tattoo just to make sure.
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Two related ideas:
In many transactions, each party has separate representatives. (Buying a house for example: the buyer and seller each have an agent, and it's a bad idea for these to be the same person.) It seems like some of the challenges with those who participate in transplant evaluation are because their responsibility is to the hospital, not the donor. Your representative could help you understand the process, the kind of questions you'll be asked and how best to answer truthfully, and redirect to a different hospital if needed.
Separately, I wonder about a survey that asks whether you'd be willing to donate a kidney and, upon receiving an affirmative answer, pivots to "great, let's get you scheduled".
Perhaps these could even be combined: those who express interest in donating are assigned a donor advocate who acts in the prospective donor's best interest, helping them to reflect on and make an informed decision, and then guides them through the rest of the process.
"I resent being treated as the dupe of an ideology that I helped form."
And I resented your initial blog post on this topic, but I didn't say anything at the time. Now I'll say something I suppose.
You've been duped by an ideology that you helped form. This ideology doesn't even sound correct or good to most normal people (your simplistic notion that it's just trying to do the most good is as ridiculous as a Communist trying to say that Communism is just wanting equality for everyone), and it has done extensive damage to the world as it stands. Oh, but somewhere some people were nice to you or something, so who could have predicted that FTX was a scam? I would have said it was probably a scam, because I think EA is an obvious hotbed for scams. Everybody who dislikes EA's would have probably said it. But you've donated a kidney and others have too, so all's well that ends well. You can calculate this scientifically or mathematically or something, using methods that your cult finds convincing, as do high prestige morons.
Bodily integrity is not a heuristic. It's not a weird moral rule, some kind of basic assumption for practical purposes. Not everything is a heuristic, heuristics are for decision making especially in mathematics and social science fields, they aren't identical to priors, or moral values, or sentiments, or traditions, or any of the other dozen alternatives that would lead somebody to dismiss your kidney argument out of hand. But if you think these are actually all synonyms, maybe use some of them for once.
More importantly, there is an alternative phrase for bodily integrity. Bodily sanctity. Far from being some weird moral rule, a strange exception or random thing, this is an explicitly stated position in the biggest religions in the world, religions that have been far more dominant in the past than now. Here's a heuristic for you, what is old is tried and tested, what is new is probably wrong, and your entire world view doesn't extend before the modern era. I don't want to hear about "exceptions" from people who can't identify what is and isn't a heuristic, and can't fathom why anybody would believe in bodily sanctity, or understand how it works for normal people (not all of this is targeted at Scott specifically). As much as I don't want to defend somebody when they didn't ask for it, when Stephen made his comment, I would say his comment was a heuristic only in the sense of being a blog comment, not as a moral position. Because Rationalists are so weird, and not in a good way, it would take a lot of time to explain extremely basic and widely held notions of the sanctity of the body, the difference between the essence of an object and its particular instance, what is and is not the "body" in the specific way under discussion, etc. So you fall back on simplistic version of the argument, accept that exceptions can be found under this simplistic version, and try to move on for the sake of discussion.
And I'm not even of the opinion that one shouldn't donate their kidney. Sure, do it, it can be altruistic. But it can also be a bad thing. Perhaps it can be bad when you make a blog post about it to a large number of people in an attempt to convince them to offer up their organs in the name of your cults and the false god QALY.
How is what you are saying isn't a universal argument against anything that has ever failed in any way? Why can't we use it to declare capitalism a scam after the first financial crisis? Or whole human civization a cult after the first war? And don't even get me started about religions.
Because the majority of "normal people" - a very conviniet category, by the way - are supporting them? So in all essence, it just ends up being boring concervative argument about status quo that you've rewritten in the least nice way towards Scott in particular? Or am I missing something?
I had a similar feeling from the article that I phrase like "there are all these people screaming at me to do X because that will make me good, and it's pretty obvious that they're really fucking wrong, so why is Scott any different?"
Also, nearly copy-pasting from my comment (sue me). Every memeplex (EA/idpol/religion) eventually gets more complexified and enthusiastic and thinks they are the solution to all problems. Communism did that. A bit of communism (thx Canadian healthcare), a bit of charity (maybe not EA, just like donate to your local food bank), a bit of hedonism (ska shows 4eva), a bit of capitalism.
I often think that the specialists are all wrong, and the most enlightened people are the mids who just keep acting like monkeys with slightly more advanced brains. The specialists are too focused on one thing that is THE BEST THING! We can benefit from their specialization if we don't listen too much.
Well, could you assess his arguments on the merits, to see if he’s obviously wrong like those other people?
> I would have said it was probably a scam, because I think EA is an obvious hotbed for scams.
Would you be willing to predict in advance which other EA organizations will turn out to be scams?
Given sufficient time, all of them. It's not just EA, I think most charity organisations are probably scams. EA is only different because it is popular among certain high prestige groups who have money to both lose and desire. I will also note that at least part of this popularity is due to the general belief that charitable organisations end up as scams in the long run, and so EA can do better. Be more"effective" if you will.
Of course I understand your real point. It's easy to say after the fact that you knew X all along. I'm not claiming prophecy in this instance, merely cynicism on the effectiveness of EA and the motivations of those involved.
"I resent being treated as the dupe of an ideology that I helped form."
As a member of the "the group of people who kill your cattle on the full moon while chanting*" tribe, I had to smile at this one, since we're used to getting the "you are a dupe of the ideology" treatment from the rationalist/atheist/materialist/non-believer except in science side.
Welcome to the Religious Nutjob side, Scott, we have Death Cookies**!
I do think Scott did something admirable by donating his kidney, and I do think he is free to do so if he wishes, but that's because I'm one of the full-moon chanting cattle-killer types and we've been stuffed chock-full of tales of people who do self-sacrificial things 🤷♀️
*Well, technically weekly cannibal feasts of flesh and blood, hymns optional, but close enough right?
https://www.youtube.com/watch?v=Gazna4HcU18
** You wouldn't doubt Jack Chick, now would you?
https://www.chick.com/products/tract?stk=74
> but somewhere some people were nice to you or something, so who could have predicted that FTX was a scam? I would have said it was probably a scam, because I think EA is an obvious hotbed for scams. Everybody who dislikes EA's would have probably said it.
But it was a crypto scam. So the reason to think it's a scam is it's crypto.
If SBF had stolen all his clients' money to give to the AMF, then he would be based and cool (though a criminal and bad PR), and you could easily argue it would be an EA thing. But that's not what happened. He just punted all the money on stupid crypto bets. I have never seen someone discussing SBF in his own right go "he's bad because EA." At best you'll see "he was using charity to whitewash his own sins." Which doesn't require EA at all, and exists basically as long as wealth concentration has been ongoing.
I tend to support crypto. I also support the idea that crypto is basically 100% scams, and that predicting the FTX implosion was doable from the crypto angle just as it was from the EA angle. It was a crypto scam and all crypto is a scam the same way all of EA is a scam.
However, it isn't true is that SBF simply lost a bunch of money. He donated around 100 million dollars to various political organisations and candidates, which is where most of my practical ire of this particular situation comes from. It's one thing to give massive amounts of money to politics. It's quite another to steal it first, and then give it to politics.
I understand your point is that EA is not intrinsically bound to how this particular scam operated. Fair enough. He could have used any charity type thing to mask his crimes. I'll amend that I think basically all charities are scams, even if the concept of charity in itself is not a scam. EA is worse than charities generally, because it thinks itself better, more "effective", and does so on logic that I find obviously wrong and reprehensible. It is this logic specifically that is rife for abuse, beyond what normal manipulation would allow.
1. Most religions are not big on bodily sanctity, it even feels somehow heretic and idolatric as a concept. A weird flavor of New Age pseudo-Buddhism or nietzschean Vitalism that I doubt would sit well with most churchgoers
2. If you accuse a group to have done bad on the net, it's usually good form to bring receipts. And I say this as somebody pretty contemptuous of EA on an intellectual level, I can't really see how malaria nets are somehow out weighted by whatever your pet peeve is
3. "You believe to be doing good and be rational, just like the communists believed to do good and be rational, suspicious uh" sounds like a partisan and hamfisted parody of a conservative, wild seeing somebody saying it out loud
On the subject of what I said about religions, I didn't say "most" I said "the biggest." Beyond this lapse in reading comprehension, your claims here are not just wrong, but ridiculous beyond all parody. Let's very quickly go through the largest religions.
For Christianity, please read 1 Corinthians 6:19-20.
As a bonus for Judaism, please read Leviticus 19:28, in which bodily sanctity is considered to be avoiding idolatrous practices, which is literally the opposite of your nonsensical supposition.
Islam shares with Christianity and Judaism the basic idea that man was created in God's image, and indeed, At-Tin verse 4, says humans were created in the "best" form. It is Ijma, consensus, that Islam condemns mutilation of the body and even explicitly includes tattoos in that. Sahih al-Bukhari 5944, for example, is clear on the latter.
Hinduism is more varied, but even Dualist schools like Samkhya-Yoga understand that the body is sacred because it is the vessel of the divine Self. Ahimsa applies even to one's own body, and is also a tenet of Buddhism.
Now of all these religions, there are overriding principles to Bodily Sanctity that could be applied in organ donation. None of these religions forbid organ donation in principle. However, Scott's method of arguing the position is so horrendously anathema to all reason that I wouldn't see it as difficult to argue that Scott did something idolatrous/prideful. Admittedly only for the Abrahamics, I am not that learned in Indian religions.
As to your second point, FTX itself outweighs malaria nets if that is the kind of thing you're looking for from me. But if you agree with me that on an intellectual level EA is contemptuous, you might at least appreciate my position that the philosophical commitments EA makes are in themselves damaging to the world in the way that open avocation of Eugenics is commonly seen as damaging. I may not want to ban such apologetics, but that doesn't mean I must hold my tongue if I don't feel like it.
To your final point, you've completely missed my point. The analogy is not to compare if or how these groups have false beliefs, but rather, that the summation of their own position is clearly simplistic to the point of being basically lying. If Marx rose from the dead and tried to tell me that the summation of his thought was "equality of everyone", I'd call him a liar not because Marxism lead to Gulags or whatever, but because Scientific Materialism is so fundamental to the Marxist world view that making no mention of it is tantamount to propaganda. If it hurts your sensibilities to use Communism as an example, I would say the same thing about a Christian who said that the summation of Christianity was "Do unto others as you would have them do unto you."
I also value body integrity, but differently- not as a heuristic, it is something I actually feel strongly about. Even a thought of some internal part being taken away feels awful, even if it’s a part that doesn’t make a difference. I don’t really feel like the hair (except maybe for the follicles) is a part of it, I feel strongly interventions that don’t make the body in the long term different from what it was, I would suffer but agree to a removal of something that contains cancer. Vaccinations are fine, as they don’t take away or change anything. Piercing’s not fine, physically don’t like the idea. Donating a kidney to someone in need is not fine, even if it didn’t affect anything in the body, because I’d feel bad about missing it, not having it connected to the rest of me anymore, etc., so unless it is somehow really important (a close relative needs it), I wouldn’t do it, this is not a resource I’m happy to use to improve the lives of others
The fact that you have strong feelings about X, doesn't mean that it isn't a heuristic. Likewise, the fact that you have strong belief in laws of Newton, doesn't mean that they are not just an approximation of General Relativity, which itself is just an approximation of some deeper fundamental law of the universe.
Think about it in terms of objective morality. Your feelings are hints at what is moral but they are not necessarily unfailable - after all different people tend to have different feelings occasionally. So it seems plausible that they are approximations of some kind of real moral principle. One of such principles can be called "body integrity with caveats". It approximates feelings of some people quite well, though there seems to be a lot of disagreements about what exactly the caveats are supposed to be. And there are all kinds of other principles, so it really seems that there is some deeper moral law, explaining them all.
Sure, most of what humans feel like they value is related to heuristics that were useful in ancestral environments- or at least is acquired through heuristics for starting to value stuff which were useful in the ancestral environment.
It doesn’t have a feeling of morality to it- it’s not something that I consider universal. I feel bad for people who lose parts of them or even just do piercings, but I don’t feel like it’s immoral in any sense. I just feel like I’d be uncomfortable in their situation. People should be approximately* free to do whatever they want with their bodies, and I believe in this strongly, as a heuristic that has utilitarian justification. I don’t think the way I feel about integrity is in any way related to utilitarianism, though. It’s something I actually value, on its own, personally, not as a policy for achieving other means. Like, even if there are evolutionary reasons that make us enjoy ice cream, they don’t at all screen off liking ice cream.
(* I would like it to be hard-by-design for people to shoot themselves in the foot, but if they still go through the hardships to still do it, they should probably be able to)
Sure, but you value it *for yourself*, as a personal preference. I don't think you believe it to be a universal moral value which you would impose on others.
Yep
Right. Well, that's different from Stephen — I think (at least as interpreted by Scott) Stephen was trying to assert that it was a rule which he thinks should apply to others even when their expressed wish is to do otherwise. That's where the heuristic framing came in — "it only looks like a universalisable would-be moral rule because there's a reasonably universalisable *heuristic* that looks a lot like the supposed absolute rule". I don't think Scott has anything against idiosyncratic personal preferences.
(It's the same argument as heterosexuality vs. homophobia; nothing wrong with being personally grossed out at the prospect of gay sex, plenty wrong with trying to raise that into a universal rule.)
Oh, wow. I completely failed to parse what Stephen was saying as something about a universal rule and thought it’s about personal feelings acting as a heuristic.
(😅 I think this is possibly the first time in my life I’ve been compared to a homophobe, even if one who doesn’t insist on any rules)
(You still haven't! You're the heterosexual in the equation; it's Stephen, or anyway Scott's-model-of-Stephen, who'd be on the other end.)
I liked this post and I really enjoy reading here. However, the last but one paragraph kind of churned something inside me. It is offtopic but I think still worth mentioning.
> I am proud to be an American, where I have freedom of speech, freedom to take melatonin whenever I want, and freedom to donate a kidney. You’ve got to keep exercising rights if you want to keep them, and I’m proud my country has defeated the evil bioethicists on this one and kept this option open for me.
It is weird for me is to be proud of one's country because I think there is a lot to be ashamed of for (almost?) every country (for a reasonable person) and I cannot imagine the US are an exception. Can someone be proud and ashamed for the very same thing? I think it doesn't make sense, shame and pride are opposites. Am I correct?
Also, pride of the mentioned aspects of the US society, eg. freedom of speech, is questionable in my point of view. To me, pride is a rather personal feeling. I mean how much can someone be proud of something which they have not influenced, but were lucky enough to be born in the "right" place?
(Apart from this it is also weird for me to say "American" and when actually meaning "US-American" although it is common practice.)
There's nothing weird about being proud about some parts of something and ashamed of other parts. Everything is multifaceted; you don't have to categorize everything in black and white.
I don't understand nationalism either, but it's probably just a consequence of natural human tribalism. That's not necessarily a bad thing, since I doubt it would even be possible for huge, unified civilizations to form without some sort of instinctual unifying mechanism.
Everything has many faces, I agree. That's why I have a problem with Scott claiming to be proud of something as generic as the USA. Because pride means a kind of participation, it also means participation in the bad sides which undoubtedly exist. Or doesn't it?
Sure enough, "I am proud to be an American, where ..." can also be read as "I am happy to live in a place, where ..." But the word proud adds something to it which makes me uncomfortable.
I entirely agree with that. I was about to write a long text to develop why I agree with it, but then I noticed it would just be repeating what you just said, reformulated in a different manner.
US-American isn't a thing. American is the correct word.
And I'm not seeing the issue with being proud of something that you didn't have anything to do with. Could you be proud of your child or parent?
I asked myself the same question. Being proud of something means to take some ownership in my point of view. This is, of course, a continuum. It can be very closely linked to one's own achievements, such as passing an exam, or more loosely linked to influencing a child through passing on DNA and upbringing. However, Scott's sentence (to me) leans more towards the end where it no longer makes sense, such as "I'm proud to be from California, where the sun shines every day".
There are countries in north america other than the US, to say nothing of central or south america.
This is true, but irrelevant, as no one said anything about a person from North America or any other continent or region. The term America is short for the United States of America - no other country has America in its name or calls itself America. Canadians or Venezualans don't call themselves Americans. That's just not what the word means. It means someone from the USA.
“ Sometimes they spend all their time gaining more and more power and popularity, and never get around to using it for good. ”
Reminds me of the joke about the corrupted politician.
“He started off doing good, but he ended up doing well. “
I'm a little confused by the Wytham Abbey point in the original article, and more confused by the follow up here.
The point (from Owen Cotton-Barratt's own words) was "The main case for the project was not a cost-saving one, but that if it was a success it could generate many more valuable workshops than would otherwise exist. Note that this is a much less expensive experiment than it may look on face value, since we retain the underlying asset of the building.
We wanted to be close to Oxford for easy access to the intellectual communities there. (Property prices weren’t falling off significantly with distance until travel time from Oxford and London had become significantly higher.) We looked at a lot of properties online, and visited the three properties we found for sale with 20+ bedrooms within about 50 minutes of Oxford. These were all “country houses”, which are commonly repurposed as event venues in England. The other two were cheaper (one ~£6M and one ~£9M at the end of a competitive process; compared to a purchase price for Wytham of a bit under £15M) but needed significantly more work before they were usable, which would have added large expense (running into the millions) and delay (likely years). (And renovation expense isn’t obviously recoverable if one sells — it depends on how much the buyers want the same things from the property as you do.)"
The original article seems (given Scott's participation and knowledge of the above quote (see reddit thread below)) calculated to drive rage engagement. Fine, sometimes it's good to get the blood moving. But then follow-up here also seems to forget we know why they bought the castle.
They set out looking for fancy venues right by Oxford. The fancy was part of the search, they want to own the EA conference version of the Institute for Advanced Study (a cool house in the woods. It was never "we need to save money on conference venues", it was "we need to save money on really cooooolll conference venues that are close to Oxford and inspire the soul". Fine, but setting this out as if it was somehow magically the cheapest way to do this (including converting a warehouse or cube farm office building) is baiting people into a (correct) gut-reaction of "that's bullshit".
tl;dr, the math probably works out if you include inspiring people near Oxford, but it was not a cost decision and retrofitting a warehouse was never on the table. People are riled up about this b/c it's presented (even in the EA-adjacent community) as "cost-effective to buy a castle as a convention center" when that's an intentionally inflammatory framing.
https://ea.greaterwrong.com/users/owen_cotton-barratt
https://www.reddit.com/r/slatestarcodex/comments/zgt259/utility_maximization/
I kind of wonder if there were too many American nerds in the selection committee...we see castles and think "Tolkien and D&D", whereas Europeans (and Brits) have more of a charged history with the local nobility, rich toffs owning the land and all.
If I'm being ungrateful revolting peasant, it's not American nerds, it's too many upper-middle class, college-educated brats that never got their hands dirty snagging turnips and so imagine that fancy-schmancy venues to have Big Thinks in are the way to change the world for the better.
It's the same thing that annoyed me with Christopher Hitchens versus Mother Teresa. Say that all his criticism was actually true in every detail. What was the result? Her nuns were still taking people in off the street and giving them beds and food and some kind of rudimentary medical treatment, even if it was inadequate, antiquated, and ideologically driven. What did his criticism do? What did he do? What lepers did he physically pick up? None, because that kind of practical work is somebody else's responsibility. Now we, the educated chattering class, have dismissed the Bronze Age morality ideologue for being in the wrong, we have done all that is needed. The messy, unending, 'the poor you will have with you always' work to clean the sores and bind up the wounds? Too much manual labour, too low-status, for us to engage in.
Instead, let us generate valuable workshops where the questions are more important than the answers and results are not the reason we're here:
"Having an immersive environment which was more about exploring new ideas than showing off results was just very good for intellectual progress.
(F)or open-minded intellectual exploration I think it’s better to have the focus on questions than answers. I thought it would be great if we could facilitate more intellectual work of this type, and the specialist-venue model was a promising one to try."
'There was a rich man who was dressed in purple and fine linen and who feasted sumptuously every day. And at his gate lay a poor man named Lazarus, covered with sores, who longed to satisfy his hunger with what fell from the rich man's table; even the dogs would come and lick his sores.
And when the rich man would leave his house every day, when Lazarus begged for scraps or even a penny pittance from the wealth of the rich man, Dives answered that he could not do so, for he was busily engaged in asking what’s most important to do in the world with like-minded others who want to spend time thinking about ideas not event logistics. Arranging for food or money for the poor would only take time and resources away from such experts hosting events.
But not to worry, Dives reassured Lazarus, probably at some future time the open-minded intellectual exploration in an immersive environment would generate some solution to the problem of global poverty and disease, even if Lazarus had died in misery and pain long before then.
So saying, Dives went on his way to view the site of a very agreeable location that would be perfect for such events, if it were only large enough, historic enough, and luxurious enough to attract the kinds of people fit to associate with such rich and important individuals as himself. Meanwhile The poor man died and was carried away by the angels to be with Abraham. So it all worked out okay in the end, didn't it?'
If Hitchens is correct, Teresa pretty strongly increased their suffering.
If he's correct. But what did he do to relieve it?
Groused about it in the newspapers, and that's about it. He certainly didn't get involved in setting up alternate clinics that would do Modern Western Medicine for the people lying in the gutters.
That's my gripe there: sitting around talking about how terrible the problems are is useless unless it leads to action. What action will "we have lovely conferences in lovely manor house where lovely people get lovely treatment" actually result in? If it leads to concrete actions that measurably improve the lives of the deprived and suffering, great! But if it leads to "green papers about forming committees to perform preliminary investigations into setting up action plans to propose legislation", then it's simply navel-gazing. Very expensive navel-gazing, to boot.
> He certainly didn't get involved in setting up alternate clinics that would do Modern Western Medicine for the people lying in the gutters.
I see your point, but this seems like too strong of a position. You're not allowed to criticize anything, no matter how bad, unless you do something to improve it? What if I think a given situation is fine (or at least not in urgent need of fixing) and someone tries to "improve" it but makes it substantially worse? Am I required to try to undo their mistakes before even pointing out that they made any?
You do remember I admitted you were right about Mother Teresa and even went to the length of saying so on Zvi's blog, right?
I actually agree with you on this one. I thought the malaria nets in Africa thing made sense but once it got into 'longtermism' and 'earn to give' I figured they were deluding themselves into doing what they already wanted to do. It's human nature--evolutionarily derived from the development of reason to convince other humans rather than arrive at truth in my view, due to the Fallen nature of humanity in yours. But--six of one, half a dozen of the other.
That is the annoying part. It's not "we bought the manor house so we'd have a base for fundraising for deworming, malaria nets, solving child poverty, and doing tangible good works", it's one guy pushing "when I went to these big fancy conferences in the big fancy venues I found them really impressive, why can't we do the same?" and the justification is "we can have big fancy conferences where big-wigs fly in to sit around yakking about blue sky ideas while being wined and dined. The sick, the poor and the dying? Yeah well somebody else will look after them, right?"
The funders explained that they literally had too much money and didn't know what to do with it, so they ponied up for this. Now that, post-FTX collapse and scandal, money is drying up, they probably wouldn't do so again.
You don't say.
> The UK, Canada, Australia, and I think most other European countries also allow altruistic donation; Germany is a rare holdout here.
Strange. I can't imagine why the German government would be squeamish about organ donation from healthy individuals to random German citizens. Maybe if I concentrated I could figure it out. But there's six million other things I have to do. I'll try to think about it in the shower.
Excellent point (if a bit tasteless in presentation)...I assumed that as well!
(Though when I think about it I do not see why I should be complaining about presentation...)
Actually, France allows you to donate your kidney only to someone who has been at the very least a close friend for at least two years.
"Le donneur peut provenir de l’entourage proche restreint, ça peut être : le père ou la mère, un conjoint, un frère ou une soeur, un fils ou une fille, un grandparent, un oncle ou une tante, un cousin germain ou une cousine germaine. Mais également toute personne apportant la preuve d’une vie commune d’au moins deux ans avec le receveur, ou bien d’un lien affectif étroit et stable avec la personne malade, là encore depuis deux ans minimum."
("Close friend" is an understatement; "lien affectif étroit et stable" sounds almost like "possibly platonic lover" to me.)
Possibly the horrors of World War II made German bioethics more hyper- vigilant than average?
There is some dark wordplay in Biff Wiss's comment to that effect ("concentrate", "six million", "shower").
Woosh! Thanks
I’m actually mildly annoyed at the negativity of some of these comments. Mark Twain: “No good deed goes unpunished.”
How many of the commenters criticising Scott’s decision have actually met someone on dialysis? Or after a renal transplant? I think Scott quoted a disability adjusted life year improvement from 70% to 90% but this is a scale that ranks someone with chronic untreatable depression and constant suicidality at 40%. The commenter above who felt that his time on dialysis was basically a period in limbo awaiting transplant is a typical story. Nephrologists like to say that the dumbest kidney is still much smarter than the smartest nephrologist; our various mechanical systems are vastly inferior to an actual kidney in removing bodily waste. And it’s not a coincidence that dialysis starts with “die,” the median life expectancy is around 5 years.
Contrast that with a transplant recipient who in most cases after a period of recovery can expect a more or less normal life (granted, with the aid of strong immunosuppressive drugs), with a life expectancy of 15 - 20 years. You can perhaps appreciate how grateful such a person would be.
I have no strong feelings about the philosophy of EA, but I do strongly feel that a world where more people donate organs to those in need is a better world, notwithstanding the tiny and well documented risks involved to the donor. I understand that some commenters have a vague feeling of “yuck” but see how “yuck” you feel when you are in desperate need of a life saving transplant and there’s thousands of other people before you.
(I will probably not donate a kidney but only because Scott is a much better person than me.)
Having met multiple people on dialysis, I'm reasonably comfortable saying this is an incredible superogatory altruistic act, and that if he excised all of the EA hullabaloo from the article it would've been received much better.
People who do not read the Sequences are doomed to repeat the mistakes described there.
https://www.readthesequences.com/Why-Our-Kind-Cant-Cooperate
I'm still thinking about donating and I have another dumb question. Why are there so many people on dialysis? Why isn't it the case that every person who needs one is able move someone who knows them to donate (I personally would have zero hesitation if I actually knew anyone who needed one)? Are their family members/friends/cowerkers/acquantances just sitting back letting them die?
Seems unbelievably stingy to me. Any insights on this would really help me to feel like I understand what I'd be doing.
There are several reasons for this, but one of them is that just because you are willing to be a donor doesn't mean that the person you are going to donate to will be compatible. The logistics solution for this is setting up donation "chains" where donor, recipient pairs keep getting added until 1. Someone gets added so the chain becomes a circle 2. A compatible undirected donation works on the "head" of a chain.
Keyword to search for is "paired exchanges".
Brief google search found https://www.kidney.org.uk/kidney-transplants-from-relatives-and-friends where it appears that 20% (!) of people on dialysis purposefully refuse an enthusiastic related donor.
Both of these factors don't explain all of the shortfall, but probably does explain around 30-50 %.
I think your take on the comments made me more uncomfortable with the original article after I went back and read it. Like some of the commenters you commented on, I'm trying to figure out why by writing a comment :)
TLDR: I'm glad you did it. I never downloaded the Good Person Who Just Wants To Help Human Personality Template. Kidneys seem safe to donate and have low long-term costs to the donor. I feel like you're moralizing about the best place to be on an ethical gradient when there is probably a vast savannah between the high moral peaks that EA/idpol/religious people get their climbing gear out for. I just wanna grill, man.
- I THINK the thing I'm uncomfortable with is something like "a lot of people are telling me how I should live my life and clearly a lot of them are dead fucking wrong, so why should I trust this guy?" The drive to moralizing and tinkering with optimal God Seeking Behaviour drives me wild! In my late 30s I finally came to terms with religious people who want to live under the thumb of ideology as long as they don't try to get in my face about it, just at the time when Social Justice types replaced God with identity politics and invented new idols to worship. Your framing feels like the same type of shape (triangular?) as the other God Seeking Behaviour, just using QAYL
- Any memeplex (EA, idpol, christianity) gradually gets more complexified and zealous. EA might have started out as "let's donate mosquito nets" and now is moving in to the "you should do this with your body" just like idpol started out as "this is how it feels like to be X identity, show some sympathy" and ended up at "because of your genetics you have original sin; pray with me it would be a pity if you lost your job"
- `[...] but I’m probably not going to donate a lobe of my liver [...] . 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`
- I'm pretty sure this is the sentiment that I just can't sign up for. You are judging on a moral gradient, and there are a lot of people out there judging on a moral gradient about how to be the best person. The axiology article is throwing a wrench in to me typing this during my morning coffee before work, but what if there is a vast savannah of "being pretty okay" between the high moral mountains of "being really good"? Is the imaginary Taylor Swift, Pumpkin Spice Latte, SUV commuter who donates to the food bank not measuring up or are they just "being pretty okay"?
- I have Hemophilia and it has been really shitty at times and maybe I would have loved to get a transplant from someone who could produce the clotting factor I don't (this is not a viable cure for Hemophilia AFAIK, but just ... what if), but also I absolutely hate being treated special after the first 20 years of my life being babied and coddled. I would rather be free from the obligation of a debt to a stranger. However, discounting that perspective by 30% is the fact that Pharma has done an amazing job managing Hemophilia with simple injectable clotting proteins and now some really wild antibody and gene therapy, so I have the luxury of a workable treatment that has meant I never wanted for a transplant
- Smaller considerations: I'm a bad person and kind of don't care about QAYL metrics when it comes to individual choices. I believe in society scale solutions (e.g. pay your taxes -> gov't research). I think our world would be better if more people were regularly taking Ecstasy at Ska shows, and having irresponsible sex and getting STIs than hunkering down and Being Good. All work and no play make Jack a dull boy, etc.
Georgist LVT + UBI seems like it could be a very efficient society-scale approach for enabling more people to take Ecstasy at Ska shows and so on. Anyone who prefers that kind of thing could simply spend their UBI cash on it without even being distracted by a conventional job, solicitation of charity, or means-testing. Somebody still needs to clean up any resulting messes, but would have reasonable options for getting paid a fair rate to do so.
That sounds good to me :) The troubles I imagine with UBI are in the transition period, like rents and food prices rising to meet 100% of the UBI granted to people. I'm not smart enough to know if a stable UBI system would feature $1B loaves of bread and $1T apartments, but I would expect UBI cheques in 2023 to directly increase rents and food prices like we saw with covid stimulus.
That's the beauty of funding it with a land value tax - if rents rise across the board, the tax base funding the UBI automatically increases to match.
As for food... well, there are already various entrenched precautions against food prices spiking too far, since that's been known to result in riots. In the industrialized world, food production capacity already consistently exceeds demand, so there's no need for extreme prices to allocate scarce resources, and if some agribusiness cartel tried to create artificial scarcity, they'd probably just end up destroying themselves and enriching their competitors, all the way down to migrant farm laborers and people with backyard gardens.
More likely source of short-term pain is folks with highly leveraged real-estate investments - such as every homeowner with an outstanding mortgage. They're the ones who'd be trying to stop it.
- I would rather live in a world where US/Can/UK/EU governments actually had the best science labs in the world and worked on insane future tech without the necessity of profit. The citizens of this world spend more time partying and enjoying life before their mind states evaporate upon death, than they do engaging in God Seeking Behaviour, because they know that quality of life is gradually ratcheting upwards because of the collective action. I believe this world is more achievable than an EA paradise of perfect individual action.
Being scolded for not being good enough tires people the fuck out and they just disconnect; see global pandemic/constant social justice warfare
Scott,
Thank you so much for doing this. I will be likely receiving a kidney transplant in the next six months or so from my wife. I am incredibly grateful to her for the gift she is giving me and I know someone else is incredibly grateful for the gift you have given.
God bless you.
On the subject of legalizing donations for money: I know that the original post here labelled the "seduced by a hot stranger; wake up in an ice bath" scenario as an urban legend, but if kidney donations for money were legal and routine, how many actual organ thefts might occur? I am mostly worried about the developing world here, where people are more desperate and where a corrupt doctor or official might more easily fake the documentation that a recipient would demand.
I do not think donations for money are sinful or "deontologically wrong" or sinful, but I do worry about creating a market where organ stealing might get rewarded. Has anyone made an attempt to model or quantify this risk?
To riff on Galton-Erlich-Buck, "Altruists argued, with noble intentions, that we should implement a market for organ transplants in a responsible and ethical way. Eventually, people agreed, and they proceeded to implement a market for organ transplants in a horrifying way, with voluntariness badly compromised."
Given the (small in absolute terms) number of kidneys needed annually, the broad compatibility between donors & recipients, and the high unit value to even the US government of getting someone off dialysis, I expect an above-board market to comprise adequate supply that a black market would have insufficient demand to develop.
Some coercion and exploitation like that already happens. The usual argument would be that legitimizing and regulating such a market would give potential victims access to restitution through conventional channels, whereas if the whole transaction is criminal, they're mostly SOL.
A well-defined, matter-of-public-record price would also make it immensely easier for potential manufacturers of fully synthetic organs to secure financing, since they can simply point to an unambiguous "total addressable market" and promise to repay investors with a portion of that proven revenue stream if the invention succeeds. In that case, even if systematic exploitation did increase in the short term (despite the inherent benefits of transparency, and presumably some further active precautions), it would be a temporary downside of the faster path to a permanent full solution - "yanking off the bandaid" on a grand scale. I suspect very few would complain about such human contributions being replaced by advancing technology.
That being said, I don't at all think it's an illegitimate thing to be worrying about, particularly in the context of potential for jurisdictional arbitrage, and accordingly would prefer reducing such barriers incrementally, with opportunity to confirm net-beneficial results at each step, over, say, trying to skip straight to some wild anarcho-capitalist "anyone can auction off whatever body parts they happen to be able to cram in a box and pay freight costs for, no questions asked."
I am glad to declare that melatonin is now easily available in Germany. (One still needs a doctor's "Rezept" to buy sildenafil aka viagra). Kidney donation is still highly suspect and if it for money: *straight out of hell* as the German WaPo "Der SPIEGEL" shows in https://www.spiegel.de/international/world/the-illegal-trade-in-organ-is-fueled-by-desperation-and-growing-a-847473.html: "... According to Kishore, it is "paternalistic" and "dogmatic" to try to bar poor donors from selling their body parts, since doing so could provide them with a new life.
This may sound like a valid argument when it's posed as part of an academic theory. But it crumbles in the reality of the slums of India, Bangladesh, Egypt and the Philippines. There have been studies that included surveys of people in these countries who had sold a kidney. Many of them complained of poor physical and emotional health, and the overwhelming majority had spent the money within only a few months. Their lives did not improve. In fact, many were now worse off than before because they could no longer perform heavy labor or even work at all anymore.
Most had also failed to consider that the sale of about 160 grams of tissue would marginalize them even further, so that they would end up being relegated to the same level as prostitutes within the social structure of their countries. Moldovan organ donors told researchers that they were berated as "one-kidneyers" and "half-men," and told that now they would never be able to find a wife. ..."
Bizarre.
Makes sense to me; you're signaling all bad things.
"I do psych evals for surgery sometimes, and I’ve read the papers on how to do them, and the official criteria all seem pretty reasonable, so I have no idea where these people are getting this from or, how they possibly go so wrong."
I'm gonna hazard a guess at: lawsuits. I did a quick Google about "lawsuits for organ donation" and you get a nice selection of results where everyone is suing everybody else about "you took organs without consent", "you are sending harvested organs out of our state to the big cities", a really sad one about "the recipient contracted cancer from the donated organ and died" and plenty more.
Here's a lawfirm giving a handy rundown of "can you sue and on what grounds?"
https://www.legalmatch.com/law-library/article/organ-transplant-lawsuits.html
"What Proof Is Needed for a Transplant Malpractice Claim?
In the context of a medical malpractice claim, professional negligence is negligence that is committed by:
Doctors;
Nurses;
Healthcare providers;
Hospitals;
Other institutions.
Professional negligence involves a failure to do something that a reasonably prudent doctor, nurse, medical provider, hospital, or other institution would do. Professional negligence may also arise when one of these parties does something that a similarly situated party would not do under the same circumstances.
Jury instructions that are provided in professional negligence cases ask that the jury consider whether or not the party on trial was negligent. The jury will be instructed to consider all opinion testimony from expert witnesses.
Can I Sue for Failed Organ Transplant Surgery Even After Signing a Waiver?
Yes, it may be possible for an individual to sue for a failed organ transplant surgery even if they signed a waiver. Waivers can vary greatly, so it is important for an individual to review what they are signing prior to their surgery.
A waiver is a document that indicates that the patient understands they are waiving their right to a claim. Medical waivers are attempts by service providers to avoid legal liability from injured patients.
Medical waivers are often very broad and will try to include all injuries and losses. Simply because an individual signed a waiver does not always mean it will be enforceable."
I can see hospitals deciding to err on the side of caution because of CONSENT CONSENT CONSENT*. Suppose someone donates an organ, then a couple of years later they regret that decision for whatever reason. Maybe they decide "I never really wanted to do that, it must be somebody's fault, it must be the hospital is to blame!" and they go see a lawyer.
"How did you feel the day of the operation?"
"Well, I was anxious and worried and scared"
"Did the hospital do anything?"
"No, they never asked me, just went ahead with the operation"
BINGO! The hospital failed in its duty of care to a vulnerable person, so now we're going to ask for $$$$ in damages.
So now all the legal advisers to the hospitals tell them to make sure to ask the potential donor how they feel.
"How did you feel?"
"I was anxious and worried and scared"
"What did the hospital do?"
"They asked me how I felt, and I told them, and then they went ahead with the operation"
BINGO! This was coercion, and we're going to ask for $$$$$ in damages!
So now the hospitals are advised that not only do they have to ask and make sure the donor still wants to go ahead with it, they can't go ahead unless the donor is happy to do so.
And no, having your staff psychiatrist chat to the donor for ten minutes before they go under isn't good enough, because the potential donor could feel persuaded/intimidated/coerced into going ahead. So you have to make sure they have plenty of time to be absolutely sure they want to do this. Hence the six months of therapy routine. Because all the legal decisions in cases that went before about "how did you feel"/"did the hospital ask how you felt"/"did the hospital offer you any guidance or support?"/"did you feel pressured into going ahead?" are now precedent for any subsequent court cases.
*Think of all the media articles about "sure, we were in a relationship and sure, we were having consensual sex but that one time I wasn't really in the mood but had sex anyway and now looking back at it five years later that wasn't consent so it was rape".
Here's a nice tangle to try and sort out: that's my kidney! no, the other one as well!
https://law.justia.com/cases/new-york/court-of-appeals/2006/2006-09320.html
"The case before us involves the purported gift of a kidney to plaintiff.[FN*] He asserts that as the specified donee of the organ, he{**8 NY3d at 47} acquired a property right in it, giving rise to claims [*2]against defendants for delivering it to someone else. Plaintiff brought suit in federal court, and the United States Court of Appeals for the Second Circuit has certified questions to us relating to whether he has rights that would support his common-law conversion action or a statutory claim under Public Health Law articles 43 and 43-A. I
In August 2002 Peter Lucia died at defendant Good Samaritan Hospital on Long Island, from massive intracranial bleeding. His widow, Debra Lucia, sought to donate his kidney (or kidneys[FN1]) to plaintiff, Peter's longtime friend who had been suffering from end stage renal disease. Debra proceeded by going through defendant New York Organ Donor Network (NYODN). NYODN transplant coordinator defendant Spencer Hertzel concluded that Peter's kidneys were "not a perfect match, but they [were] good enough." Peter's left kidney was airlifted to Jackson Memorial Hospital in Miami, Florida, where plaintiff was awaiting its transplantation; Peter's other kidney remained in New York.
While preparing for the transplant during the early afternoon of August 23, 2002, Dr. George W. Burke, a surgeon at Jackson Memorial, inspected the donated kidney and discovered an aneurysm of the renal artery, making the kidney unsuitable for transplantation. He immediately contacted NYODN, asking for Peter's other kidney, and was informed that it had been allocated to someone else. The parties agree that NYODN had allocated the other kidney to another patient at about 11:25 a.m. that day."
From 2008, a real life version of the Surgeon Thought Experiment:
https://www.nytimes.com/2008/02/27/us/27transplant.html
"On a winter night in 2006, a disabled and brain damaged man named Ruben Navarro was wheeled into an operating room at a hospital here. By most accounts, Mr. Navarro, 25, was near death, and doctors hoped that he might sustain other lives by donating his kidneys and liver.
But what happened to Mr. Navarro quickly went from the potentially life-saving to what law enforcement officials say was criminal. In what transplant experts believe is the first such case in the country, prosecutors have charged the surgeon, Dr. Hootan C. Roozrokh, with prescribing excessive and improper doses of drugs, apparently in an attempt to hasten Mr. Navarro’s death to retrieve his organs sooner."
Suing over alleged wrongful donation:
https://www.fresnobee.com/news/local/article215781030.html
"On Nov. 17, 2017, Brittany O’Connor tried to kill herself by strangulation. She was rushed to Community Regional Medical Center in Fresno where she was not expected to survive. What happened next is the focus of a Fresno Superior Court civil lawsuit that pits her father against Community Regional Medical Center and Donor Network West, a multimillion-dollar nonprofit that connects organ donations to people in need of transplants in 40 counties in California and Nevada. In his lawsuit, Terence “Mike” O’Connor Jr. accuses Community Regional Medical Center and Donor Network West of harvesting his daughter Brittany’s organs without his permission. His attorneys, Fresno lawyers Thornton Davidson and H. Ty Kharazi, contend it’s not the first time Community Regional Medical Center and Donor Network West have skirted the necessary approvals. They have accused the two entities of engaging “in a pervasive and unlawful scheme to harvest organs from terminal patients” by denying other parents, guardians or their lawful representatives the right to object to an organ donation."
On the pig kidney thing, my partner works for the company doing that work, and it has been really interesting to hear about it from a laymen without a science background. She even got to visit the genetically modified pigs. One fun fact about them: if you have a red meat allergy (like from the Lone Star Tick) you can still eat the meat from their pigs, because they are bread without the protein which your immune system incorrectly responds to.
While I believe that so far they only attempt at kidney donation has been hooking the kidneys up to a patient who was in a coma, my understanding is that it went pretty well? The test stopped because they pulled the plug, so obviously the long-term impact has not yet been studied.
The more newsworthy donation attempts have been two heart transplants on recipients who did not qualify for transplant and were about to die anyway. The first lived for two months but eventually succumbed to pig herpes. The second seemed a lot more promising and was doing well until dying suddenly 6 weeks after surgery. The reasons for the abrupt failure are not yet public (and might be unknown by even the involved team, I don't have any non-public information on this one).
If anyone has any questions I'd be happy to ask my partner about what information she can provide that is sharable.
Here's a question about chiral organ growth:
Seems like the problem of bridging from organoid to organ is that it's too complex a development process to understand/direct at the microenvironment level manually. But wouldn't most of those signals be interoperable with, say, porcine signals in a developing fetus? What if you identified the somatic cells in a developing pig fetus that are destined to become the kidney, then exchanged them with human cells at that point (post-fertilization)? It would be delicate work, of course. Back in grad school I had an opportunity to try out the system they used for SCNT and it was really tricky. But if it worked, and you could transfer a human renal organoid into a developing pig fetus, the pig's system would take control of all the signals to create the structures that are too complicated to direct in vitro.
I guess the biggest problem with that approach would be if the vascular endothelial cells originated from the pig and not the human cells. Then you'd end up with rejection due to vascular collapse after attempting to transplant. Is this something they've tried and rejected as unworkable?
Something I forgot to ask on the original article, but that I’m still wondering about: how much difference does it make, both for the donor and the receiver, *when* then donor donates? Would there be a benefit/detriment to either if a prospective donor that is 25 years old waits 5 years, 10 years, 20 years, 40 years before donating?
>"if someone invents something new which is approximately as body-integrity-violating but also >approximately as beneficial as vaccines, Stephen will support it."
At this point we can easily imagine sci-fi style robotic/cybernetic/whatever implants being available by the end of our lifetime. Pacemakers are already kinda-sorta that. But there's a shared revulsion to these things, even among sci-fi fans who are already pro-science and imaginative. Star Trek's main villains for the past 30 years are the Borg. Star Wars villain Darth Vader is considered an abomination for being "more machine than man, now". Even the genetically-enhanced doctor on Deep Space Nine is afraid to continue adding cybernetic implants to an important religious leader and friend, on account of a fundamental fear that what comes out the other side would not be the same man. Point being, even a futurist open-minded audience shares this heuristic and has a visceral fear of crossing certain lines with regard to bodily integrity.
I would assume this commenter would decline robotic implants. "Hey you let us put this vaccine in you to boost you immune system, why won't you get this robot eye that sees 1000 yards and lets you change your eye color at will?" There is a primal sense shared by most people that you don't want to mess around too much with your body, ancient cultures were frightened by tales of chimeric creatures, and most in modern society find it unsettling to see people with bizarre piercings all over their body.
I don't think donating a kidney is disgusting in that way, I'm glad Scott feels good about having helped somebody even if it's not the sort of thing I would do. But I definitely have a tendency to view the body as a system you can horribly wreck by tinkering around with a thing here and a thing there, and that our incomplete knowledge of the body leaves a lot of room for me to fall back on "for every intended consequence, there's 3 unintended consequences". Normalizing kidney donation may well be a net benefit, but there IS a line beyond which I would not want to normalize screwing around with our bodies even if it it was beneficial on the face of it.
Intellectual contortions presented as moral reasoning that invariably culminate in an altruistic obligation. All of this ignoring epistemic difficulties like The More Data You Have, The Further You Are From the Truth (https://www.youtube.com/watch?v=fuFzv1AwBKQ) and how the removal of a kidney is exactly the sort of situation that ought to evoke Chesterton’s Fence (https://fs.blog/chestertons-fence/) type trepidation. Human physiology is complex to an extent that our modern understanding, robust as it may be, cannot reasonably dispel such hesitation.
The motive behind your crusade is a conception of altruism that I find offensive, one that insists we extract and metricize our virtue, that our sense of self-esteem ought to be derived extrinsically. You shouldn’t feel good about yourself unless you justify your existence through others. Forget yourself and serve the common good, and you can bask in the feeling of pristine self-righteousness, crowd-surfing on imaginary borrowed esteem. But it doesn’t satisfy the feeling of moral insufficiency that compelled you in the first place, so you seek to convince others as a form of reaffirmation. In this way, it’s contagious – like religion.
I might donate a kidney to a close friend, but nothing could ever convince me to donate one to a random stranger, and I think the impetus to try is deeply immoral. I don’t suspect you of lying, but I’m terrified of what you honestly seem to regard as moral action.
Given what you’ve written, why would you donate to a close friend?
Do you see a contradiction?
Well, you haven't discovered why the chesterton's fence exists (or else you would have explained why undirected donations are violating the no doubt very good reasons for not giving), nor apparently do you have enough data to say that donating the kidney is net good for your friend, which is why I presume you linked to a video explaining why cancer treatments can be confounded by a naive reading of the data, hoping to draw a parallel between that and donation.
You've misunderstood the objection entirely. There is absolutely sufficient evidence that kidney transplants are lifesaving, whereas there is no chance whatever that we have a comprehensive understanding of the totality of consequences involved in removing a healthy person's kidney. My willingness to face the uncertainty of those consequences for a friend, but not for a stranger, constitutes neither a contradiction nor a moral shortcoming. I submit that the desire to conflate these two actions, and call it altruism, does.
I mean, you were the person who invoked chesterton's fence on this entire affair and I still do not see how what you said actually takes down the fence, other than "because I thought my friend is more important than the fence", in which case what is good for the goose is good for the gander. Most people in fact do not donate kidneys to their friends, so it sure looks like you're not obeying your own precepts and ignoring Chesterton's fence.
I think this type of donation to friends is excessively self congratulatory, especially considering how immoral it would be to donate to a friend when a family member could need it too.
In fact, even when a family member gets a failing kidney, they need to understand that you have to put on your air mask first and that not donating is in fact the best possible outcome. After all, people who donate their organs to family members do have markedly higher esteem and mood afterwards, which just shows you how suspect the foundation for this entire house of kidneys are.
(Edit typo fix good -> goose)
You seem really hung up on my invocation of Chesterton's Fence, but you've misunderstood how it fits into my argument... again. I'm going to take one more stab at explaining this.
Since our working knowledge of human physiology is incomplete, we can't know what sort of long-term (or nth order) effects removing a kidney might have. Therefore it's perfectly reasonable to maintain reservations about the procedure. This is true even when you present a bunch of studies to demonstrate that the operation poses little risk (as it's defined by the study) to your well-being (as it's defined by the study).
Chesterton's Fence is just a principle expressing the logic behind that sort of hesitation over unforeseen consequences. The reason that I invoked this principle was to make the point that, if somebody is concerned about the potential, unforeseen, long-term (or nth order) effects, they shouldn't care about the relatively narrow metrics presented in the relatively limited studies.
If you're perfectly happy to sacrifice your life in the process of donating your kidney to a random stranger, you needn't worry about the risks. But at that rate, why stop at a kidney? If the benefit (as measured in QALYs) to any random stranger outweighs any potential, unforeseen consequences to your own body, just check the donor box and prep a noose (I'm not trying to be glib, I just genuinely find this particular line of thinking personally horrifying).
As far as your comments on morality are concerned, I'll direct you to my reply (in this thread) to Tom Hitchner, since I've already expressed my feelings on altruism there.
So it seems like you agree that giving a kidney is altruistic (since it’s sacrificing an undetermined amount of well-being to save a life) but that encouraging that donation is not altruistic, particularly since (in your view) the unknown costs are too great to justify the benefit to a stranger. So your objection is not to Scott doing it, but writing about it, or at least the way he wrote about it. Is that fair to say?
Is the problem possibly the idea of a “shortcoming”--you’re picking up from Scott the implication that someone is morally deficient if they don’t do this? I feel like that’s more binary than Scott was implying. An analogy to financial altruism might be helpful: all else being equal, giving 10% of one’s income is more admirable than giving 0% or 5% or 9%, and less admirable than giving 12% or 15%. But that doesn’t mean that giving 10% or 5% is a “moral shortcoming,” partly because all else is never equal and partly because, since no one can give 100%, there isn’t a minimum level of contribution we can set, short of which we have a “shortcoming”; we have to work out the contribution that we’re able to make, and strive to make it as big as we’re comfortable with.
First of all, thanks for actually taking the time to read my comment. You're a breath of fresh air compared to the other guy who seems to be popping off for no reason. I can tell you've really tried to understand my position.
That being said, I think you're reaching a little in the search for common ground. My issue is with altruism itself, which shouldn't be seen as having a monopoly on human decency. The notion that selflessness ought to confer some moral value to an act, leads to absurdity. Selfless beneficence becomes the unobtainable moral standard for virtue, and people scramble over themselves and each other in search of an act that nobody could suspect of selfish motives.
[EDIT:
I should mention that the inevitable conclusion of this Race to the Bottom looks something like how Scott describes the experience of his prescribed kidney donation:
> "It starts with wanting, just once, do a good thing that will make people like you more instead of less."
> "You want to do just one good thing that you’ll feel unreservedly good about[...]"
> "When I woke up in the recovery room after surgery, I felt great. Amazing. Content, peaceful, proud of myself. Mostly this was because I was on enough opioids to supply a San Francisco homeless encampment for a month. But probably some of it was also the warm glow of having made a difference or something. That could be you!"
The dogged pursuit of a clean moral action probably speaks volumes about how a person regards their ordinary, everyday existence. I realize that the implications of this could seem insulting, but that's not my purpose.
/EDIT]
Convince people that selfish acts are dirty and selfless ones are clean and they'll spend the rest of their lives with a unshakeable feeling of moral insufficiency. They'll resent themselves for constantly getting in the way of their own righteousness, and they'll adopt self-censure as the guiding principle of their lives. Altruism is, in this way, antithetical to self-determination.
If I donate a kidney to a dying friend, it won't be altruism motivating me. Not a selfless concern but a very selfish one, which is - in my submission - the source of all genuine acts of kindness and human decency.
Scott's comment in Section 5 of "it seems borderline enough that I’m still sticking with my heuristic of “IDK irradiating my body seems high risk of being bad” and his further offhand comment in Section 9 about being "way way way outside the bounds of common sense" strike me as pretty decent refutations of his rebuttals offered in Section 1. It seems, at least, non-standard to judge a tiny radiation risk from a procedure most people do without much worry, more seriously than 'IDK removing an organ seems high risk of being bad,' and that would bring it into the realm of "common sense," to which Scott later appeals. I don't think his interlocutors are arguing much differently than he is, just with different "IDKs" and "common sense."
Bear in mind that a multiphase abdominal CT has roughly 4x as much radiation as a standard abdominal or chest CT. Most people, especially young people, would (or should!) have some anxiety about doing four CT scans back to back
OK, but most people, especially young people, would (or should!) have some anxiety about losing half their kidney capacity. That's the point; the arguments are isometric.
Strictly speaking it’s less than half the kidney function because the remaining kidney hypertrophies to some extent. But OK, call it 30% of kidney function, still a significant amount.
I think the point here is not to discount the ~1% chance of going into renal failure in older age as a result of kidney donation (which is similar order of magnitude to chance of developing cancer from multiphase abdominal CT; call that 0.2%); the point is that it’s a small risk to take compared to the benefit for the kidney recipient. It’s quite an altruistic act.
I suspect if you asked Scott if he could somehow produce a kidney by undergoing a multiphase abdominal CT scan and accepting the risk of cancer that entails, he would say yes to that too.
You get priority for future kidney transplants, and for your family too or did I remember that wrong?
Based on LNT his extremely cautious ex GF found the risk to be massively higher. It may actually be roughly equivalent even if LNT is quite false as it's in the threshold zone
(1)
"Here’s a sort of daydream: some charity gets the list of the 40,000 people who are predicted to die next year for lack of a kidney. Then it chooses 40,000 random Americans in a 1:1 correspondence with the kidney patients. Then it sends each of those random Americans a letter, saying “Dear John, you have been paired with Bob Smith of Topeka, Kansas. He will die of kidney failure next year unless someone donates a kidney. We have randomly selected you as a potential donor. If you say no, we will not randomly select anyone else, and Bob will probably die. If you’re willing, please call this phone number.”
There’s some sense in which this charity would be doing zero work - just choosing random names from the phone book! - but it sure would be an interesting experiment. Would 25 - 50% of the people involved really go for it? I don’t know."
Two possible answers from me (and the second is the much more likely one):
(a) "Dear Prodnoses, I am terribly sorry to hear about poor old Bob. Certain to die, you say? In that case, for the minimal sum of, let's say, five million dollars I'd be more than happy to give him one of my kidneys. You cannot put a value on life, after all, so I'm sure Bob and/or his family would be willing to recompense me for the time and inconvenience in order to save their loved one. Bank details to follow as soon as you send me acceptance of my terms, love and kisses, Two Working Just Fine Kidneys-Haver"
(https://en.wiktionary.org/wiki/prodnose)
(b) "Dear Busybodies, I'm sorry to hear that Bob is in such dire straits. From a sudden and unprovided death, deliver us, O Lord. However, since Bob knows his death is nigh, he will have time to prepare for it, and isn't that a blessing? This bit you include about kidneys, I'm not entirely sure what you are hinting at. Since I don't know Bob or the sky over him, why am I going to give him a kidney? You are labouring under a misapprehension there, my friends. Well, best wishes and tell Bob I'll pray for his departed soul! Your friend, Taking All My Bits With Me To My Grave".
(2)
"Comments From People Who Are Against This Sort Of Thing"
You know I had to do it:
https://www.youtube.com/watch?v=gT9xuXQjxMM
...Geez. It's fine if you don't want to make a sacrifice for a complete stranger, but you don't need to be such a jerk about it.
A bunch of people I don't know randomly select me to try and armtwist me into donating an organ to a stranger, and *I'm* the jerk?
Look, most people are going to go "will I get paid for this?" or "I have no idea who this guy is, I'm not obliged to help him". If that's being a jerk, then okay: we're jerks.
People who want to donate are admirable. But trying to emotionally blackmail strangers into donations out of the blue is not going to work.
> trying to emotionally blackmail strangers into donations out of the blue is not going to work
...I mean, elsewhere, it demonstrably does?
Charities do in fact raise money by randomly sending letters / going door-to-door / accosting people in the street asking for donations to help complete strangers, and successfully get a large portion of their funds this way.
Blood banks also do this kind of thing and get some donors signing up this way.
I support kidney donation, yet I have to grudgingly agree with Deiseach on this one. The method outlined by Scott in the OP seems like a flagrant violation of bioethics. I do clinical research, and if we worded our informed consents anything like how it's worded by Scott we'd get a strongly-worded IRB rejection letter in return. And in this case I'd agree with the decision. ICH GCP strongly prohibits this kind of coercion, and with good reason. We've walked that path before in medicine and it led to bad places.
But also, this reminds me of the debate back in the Bush era about public funding for stem cell research. Personally, I have no ethical problem with it, but I also recognize that *public* funding requires *public* support. I knew people at the time who strenuously objected to the research feeling it was a deep betrayal of their ethical standards. The idea that their government used their taxes to - as they saw it - commit atrocities, spurred them into activism and distrust of public research funding in general. At the time, I heard arguments from the other side, saying we should ignore the naysayers and publicly fund it by any means necessary. They cited the many people who could benefit from the short-run ideal of running rough-shod over having to seek public support.
As someone who saw the benefit and disagreed with the ethical harm, I nevertheless sided with rejecting public funding. I don't want support for research funding to become the next battle ground in the culture war. Same with kidney donation.
Unless we get widespread adoption of tens of thousands of lab-grown kidneys in the next few years (probably <1% chance) we're going to be relying on the public supporting kidney donation MORE. It seems like burning this bridge wouldn't just prevent us from getting back to the other side of the river, but also prevent us from getting the reinforcements we know we need.
Chuggers get the boot from me. I once made a donation to a charity and like an idiot signed up to a list or at least allowed them to have my details.
End result? Streams of collectors to the door asking me to sign up to donate X percent via direct debit to Good Cause. I got to the point where I could recognise them on sight. I have been brusque to perfectly nice young people volunteering to do some charity donating fundraising campaigns, who were sent out with address lists of "these suckers gave money before, arm-twist them into agreeing to hand over their bank details", which was not their fault but the fault of the charity, or rather whatever marketing consultant advised the charity that this was a bonzer idea.
End result was that no matter what heart-rending emails or mass mailing campaign letters in the door I receive, they all go straight into the bin. I am happy to donate occasionally, but not to be treated as a milk cow forever and a day. They've lost more money by trying to emotionally blackmail me, because now I don't give them *anything*.
Limit the mailing list to people who've already signed up to donate organs in the event they die in a car crash, then. If 80% still refuse, and 80% of those who accept fail the health screening, then for each life saved you've irritated and inconvenienced maybe 20-30 people, or roughly a million per year (just 0.3% of the overall US population) if scaled up far enough to clear the waiting list completely. Folks on the losing end of such a policy can be compensated out of the savings from reduced need for dialysis.
I do think that would work much better; sending out a letter to Bob Smith who signed up to "yeah I'll donate my organs upon death" will have a better chance of "Huh, there's actually someone right now who needs my kidney? Lemme think about it" than simply random Bob Smith who gets a ton of junk mail in the door anyway and is half-inclined to think this is some kind of scam: "Sooooo... you're telling me that there just so happens to be this one guy who is a perfect match for my kidney and who will die unless I donate *right now*? Even though I don't remember signing up for any kind of organ donor list? And I suppose he's also a Nigerian prince who will send me on five million dollars if I agree, yeah this one is going into the recycling".
(c) "I understand that donating a kidney can be a difficult choice to make, and I thank you for choosing me to assist you in this cry for help. I would only be too happy to facilitate the process of donating your kidneys and other organs. Alas, you neglected to include your home address, and although this oversight was easily remedied, your distance from me makes a personal intervention impractical. However, I passed your request on to some local associates who assure me that they can provide a swift resolution to your problem."
I loved your article and forwarded it to my sister-in-law in Holland. She is donating a kidney to a nurse she works with. She chuckled at parts of the article. You did a beautiful thing in donating a kidney. Thank you for sharing your experience!
Not sure if this has been mentioned before, but it strikes me that the moral agency here being discussed is completely contingent on outside factors. However thorough your due diligence prior, your action stops at the door, and from thereon everything depends on a complex system of interventions, care, proper organ transport, etc. to work at near perfect levels - and for it to continue to do so. And we happen to be talking about a system where medical error is a leading cause of death or harm. I am speaking as a former ICU nurse (who has also seen 10/10 pain coming out of ORs).
There are a lot of moral actions that rely on outside factors, of course, but in such cases you can generally change how to direct your resources. I think our morality is based in intuitions without which no-one would care about rational arguments, and which prioritize observable and close effects over remote and theoretical or statistical ones - for good reason.
The action also requires consent. This is and should be a hard line in society and signals that it is not enough for something to be for the common good to be socially prescribed. You are doing something wonderful - but something that cannot be asked of anyone. A significant distinction morally, I think.
Of course, your rational arguments also occur in the context of a society where consent and individual agency are prioritized. But is it hard to imagine a highly top down society, maybe not to far removed, siding with your impeccable arguments, and distributing resources accordingly?
So what I am arguing is that seemingly universal principles can be very contingent.
I am all for individual people donating their kidneys and I think they are heroic, but a social norm where you had to donate kidneys to be considered a real effective altruist and get access to high level business networking events is pretty horrifying but also the most plausible negative outcome, requiring only that in 50 years EA reverts to the mean and starts working like normal charity fundraising, or like a normal social group, on one of the advanced levels of that "reality/imitation/symbol/imitation of a symbol" hierarchy that I don't recall the name of.
The best way to avoid this that I have thought of is to talk about how great and selfless individual people are while loudly proclaiming how unsettling it is *in general*, so that it can never become a social norm that you have to do it to be average within this extreme community.
Isn't there a more obvious objection that you can only donate a kidney once? If you give your kidney to a stranger, you can't also then give one to a dying loved one. Since (almost) everyone values loved one lives over stranger lives, there's some calculation to be done in terms of EV. Quick googling says 2/1000 Americans actively need transplants, and 1/7 adults experience kidney disease. Assuming you have at least 10 loved ones including yourself, you have to value a stranger's life at least at 1% of your own/loved ones' to make this decision.
Which is why the "if you donate altruistically, you can put 5 loved ones on the top of the transplant recipients list if they ever need a kidney" perk is very important.
Sorry if I missed it, but is this something that actually exists? I thought just you personally get higher priority if you donate a kidney (and some sources suggest even that is subject to change).
It is a list of five, but it's only for one kidney among them, but afaik this is an America specific thing.
cool paradox with being protective of potential donors being "neither selfish nor altruistic". But idk it seems pretty obvious to me
Surely if someone was mistaken about their risk from donating (e.g. had some disease that would make it massively reduce their quality of life), you would tell them that, even if you thought them donating would still be net +utils. It's like honesty. This would be true even if the donor would never connect the dots and wouldn't regret the donation.
People who feel very uncomfortable with donating a kidney feel like their discomfort (to some degree) applies to other people too, that is they're making a bad decision for themselves. It's the same things as not stealing from the rich to give to the poor etc.
(I note I'm (somewhat) one of such people and my analysis presents us as pretty cool)
I was really surprised at how much pushback you got for donating your kidney. Really strong, emotional feedback in many cases. I don't really get it.
After talking with some commentors who were upset with your post, I think part of the issue is the whole morality/axiology thing you mentioned. I think some people believe that is something is morally praiseworthy then it is morally required, and if you don't do it then you're a bad person, and this translated your kidney donation post into "if you don't donate a kidney you're a bad person" even though you kind of went out of your way not to say that.
Maybe it's because I'm a Christian that had "all men have sinned and fallen short of the glory of God" hammered into my head from an early age, but it seems clear to me that you're not trying to make anyone feel guilty for not donating their kidney. None of us are anywhere close to morally perfect, and that's okay.
I was also surprised at the pushback and I mostly agree with everything else you said, like the analysis of why people were offended, except for your last sentence. It (by definition I would argue) is not okay that we are not close to morally perfect.
Anyway, I think a lot of people think that everyone is ”basically a good person” unless they do something bad to lose that status, and don’t have the sense that being good is something that requires work, like being a good flute player, for instance.
I guess by "that's okay" I meant "that doesn't make you much worse than the average person". If nobody is perfect then it's "acceptable" to be imperfect.
>I think some people believe that is something is morally praiseworthy then it is morally required, and if you don't do it then you're a bad person, and this translated your kidney donation post into "if you don't donate a kidney you're a bad person" even though you kind of went out of your way not to say that.
I mean, he closed the essay saying people should consider it. He's not exactly calling them bad if they don't but it's not exactly *not* implied.
I'm pretty sure Scott knows the word "superogatory" and chose not to use it.
As well, the whole EA aspect. Even though Scott has pushed the 10% pledge as a way to short-circuit moral intuitions, there's a point where... if it's true that we don't have to be morally perfect, there should be a "good enough," but EA does not strike me as particularly good at letting people rest on their laurels like that (the veganism is most notorious). You'll always get cultural nudges to do something else or to do something better. For it to be okay that you've done enough, I think you'd have to disconnect from the community and just have donations on autopilot.
Likewise, here. Scott did not feel "good enough." Not only did he find something else good to do, he spent a great deal of time, money, and health to do it!
I mean, going with the same sort of Christian perspective as the original post: it is made clear to us that sinning is part of the human condition but crucially we should all make an effort to be better. So the translation should be we should all be okay one the sense of being accepting of the fact we will never be morally perfect, but we should still strive to be better. You know, in the same spirit as the whole Rationalist thing of being "less wrong".
"You know, in the same spirit as the whole Rationalist thing of being "less wrong".
EA therefore needs to establish its own version of casuistry, in order to avoid binding too heavy burdens on its adherents, and to relieve the consciences of those afflicted with scrupulosity or OCD:
https://www.newadvent.org/cathen/03415d.htm
"The application of general principles of morality to definite and concrete cases of human activity, for the purpose, primarily, of determining what one ought to do, or ought not to do, or what one may do or leave undone as one pleases; and for the purpose, secondarily, of deciding whether and to what extent guilt or immunity from guilt follows on an action already posited.
...Since the special function of casuistry is to determine practically and in the concrete the presence or absence of a definite moral obligation, it does not fall within its scope to pass judgment on what would be more advisable, or on what may be recommended as a counsel of perfection. It leaves these judgments to the sciences to which they belong, particularly to pastoral and ascetical theology.
...The necessity of casuistry and its importance are obvious. From the nature of the case, the general principles of any science in their concrete application give rise to problems which trained and expert minds only can solve. This is especially true regarding the application of moral principles and precepts to individual conduct. For, although those principles and precepts are in themselves generally evident, their application calls for the consideration of many complex factors, both objective and subjective."
EA casuists could therefore give practical guidance in individual cases about "am I obligated to donate a kidney?"
The Christian perspective is not the rationalist or EA one, though. Historically most rationalists (Scott being the notable exception) were fairly hostile to religious sentiment, even.
That at least Scott (and I think much of the broader movement) have this scrupulosity drive, of sin-debt without a saviour, can lead to some weird places. A Christian can strive to be better while knowing, ultimately, Christ has paid their price. It gives a comfort the EA-rationalist can never have, and if the EA-rationalist doesn't have the personal will to fill that gap instead? The EA-rationalist only has a bottomless pit of suffering (https://slatestarcodex.com/2014/09/27/bottomless-pits-of-suffering/) and how much of themself they're willing to toss into it.
Section IV of his What We Owe the Future review (https://www.astralcodexten.com/p/book-review-what-we-owe-the-future) comes to mind too, and I wish he'd elaborate on how that *doesn't* invalidate... a lot of EA and his intuitions here? A lot of people choose to stay on World A with their kidneys and good food instead of making all those logical leaps that wind up cutting off bits to sacrifice in the bottomless pit.
Mind you, I do think he did a very good, extremely generous thing. I also think it's irrational and that trying to put a veneer of rationality on it requires a lot of other sacrifices (I will be somewhat surprised if Scott *does not* donate of lobe of his liver within 5 years), or one has to admit that the veneer of rationality is just culturally-afflicted rational*izing*. My problem is less with giving the kidney and more with the EA/rationalist gloss on what is not justifiable in those terms.
I never equated EA with Christian morality. I merely elaborated on how the standard Christian stance of accepting imperfection whilst striving for "perfection" should make it easy to accept that Scott can justify the goodness of his donation without implying that everyone else is morally obligated to do the same - like all Christians aren't obligated to live off locusts and honey and literally give all their possessions to the poor. In this I was merely supporting the original comment.
On a separate note, I don't see how you can read Scott's whole two posts and call his decision irrational. It is perfectly fine to disagree with it on many different grounds, but it seems to me like a solid consequence of the moral axioms that Scott starts from. Regardless of whatever else his decision may be, it is not irrational.
What if the pit isn't actually bottomless, though, such that some reasonable number of people could simply get together and fill it in?
What's a reasonable number of people? 5, 10? 5 million, 10 million, 100 million? Just kidneys, or kidney and liver lobe? Maybe donating just one eye, you can manage with the other (like the kidney).
Maybe they could. Maybe they could then rest. Or maybe, like the poor that will always be with us, some people will always need A Cause.
The pit isn't bottomless, because the universe is finite. But I suspect the Pit of Possible Causes, while not bottomless, has a tendency to grow in proportion and stay larger than the Line of People Waiting to Fill It In.
Maybe I'm too pessimistic, here. Or maybe I'm just back on World A with that Scott, instead of the Scott that made a few leaps closer.
Maybe "the poor will always be with you" was specific to preindustrial contexts. Polio sure seemed like it would "always be with" humanity, until we decided to change that. Lot of kidney and liver problems are preventable, or curable without a transplant. Broad "nobody-gets-left-behind" policy can be a key part of the political pressure driving such treatment methods to be developed and implemented.
"if it's true that we don't have to be morally perfect, there should be a "good enough," but EA does not strike me as particularly good at letting people rest on their laurels like that"
Yeah, that's the scrupulosity trap right there. If you've logically argued yourself into doing something rather than basing it on 'warm fuzzies' or a gut feeling, then it's much more difficult to resist going the extra mile - "if A, then B; if B, why not C?" and so on.
Had a random thought reading this article, EA:Charity::Sabremetrics:Baseball
Meaning, people acknowledge that the statistical modeling that's been added to baseball is invaluable if you want to actually win the most games over a season, so it would be irresponsible for coaches and managers not to use it, but a lot of fans of baseball feel that it ruined the thing they loved about baseball, which wasn't actually the number of games won but the narrative experience you could randomly have watching a game where something totally unexpected would occur and you would define part of your whole life experience as being present for that moment (the classic example is seeing someone throw a no-hitter, which you will never see in the modern game because its mathematically irresponsible to leave one pitcher in for an entire game).
Anyway, EA is great at the thing that most people would assume people engage with charity for, which is helping people. But it dilutes a lot of the narrative aspect of charity that is what people really want whether they acknowledge it or not; instead of charity being a magical moment of self-discovered selflessness, its some mathematically quantifiable that can tell you, objectively, the extent to which you are really optimized for "helping other people."
Anyway, I think donating a kidney obviously sort of bridges the gap between these two experiences.
Its a very personal story where the cost-benefit analysis is still something someone in EA would accept.
A lot of the baseball issues are just exploiting problems with the rules, and could be fixed by correcting the rules. For instance, relief pitches should be banned or at least strictly limited.
I really appreciate the EA space for helping me come to the conclusion that I have no interest in altruism.
EA people can discourage you from effective altruism, but only you can discourage yourself from altruism in general.
I'm not sure about that. Effective altruists speak my language and lay bare my total instinctual aversion for all of their altruistic goals, but simultaneously I'm forced to admit they are the only rational approach, leaving me retroactively averse to the old altruism for which I had less instinctual distaste. After realizing I just would never give up a kidney no matter how safe and easy or how much it could help someone, I'm forced to admit a mosquito net is not worth my time and money no matter how cheap or helpful it could be either. I prefer to be, and will force myself to be, consistent; EA pointed out that for me, consistent selfishness is far far easier to achieve than consistent altruism. They are right about the E so I had to discard the A.
Would you not consider that a mosquito net is a much smaller investment of time and effort and sacrifice than donating a kidney, so it might be worth it because the benefits greatly outweigh the cost? I can see the consistency in "if I'm not going to do X, then I shouldn't do Y either", but again - "a foolish consistency is the hobgoblin of little minds". You don't have to be perfectly consistent every minute of the day, you're only human!
Cool story, but please forgive me if I find it psychologically unlikely. I can't imagine someone who donated money to buy mosquito nets, but after reading an article about kidney donation decided that kidney donation is too much and therefore for the sake of consistency the mosquito nets need to stop, too.
I can more easily imagine someone who *contemplated* donating to buy mosquito nets, but then decided that it's not worth it, because people who donate kidneys get more status anyway, so what's the point.
I think my opinion is relatively simple: it is obviously a Good thing to donate organs, but most people (including me) are not particularly Good. Which is fine, really, being Neutral is fine and all that should be expected of anyone. It's just weird when some people feel the need to define Good in terms of the decisions and sacrifices they personally would make.
> 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?
First of all, I don't believe it is net positive. It certainly has some positive effects, but I value a working organ more if it's working in its true owner, not someone else, ceteris paribus (sort of like how kids should be raised by their biological parents). Then there are the nonphysical negatives like the OCD/scrupulosity issue or the self-harm / self-negation issue.
But even if it were *net* positive (say it saved 1000 lives), I don't think people should make major sacrifices of their own body just to help a stranger. I think it's wrong. I think that's a harmful and self-destructive thought process, and I'd like to see it eradicated.
These discussions have made me realize that part of the reason barriers on kidney donation make me so mad is that they are an imposition onto me of the values of the medical ethics community that values status quo and not doing harm over improvement. An imposition of exactly the kind that medical ethicists insist would be immoral to do with respect to other values -- creating the impression that I'm being disrespected for being different.
In general, medical ethics requires we respect the choice of a patient to decline treatment even when the doctor is quite confident that not only will it benefit the patient but they'll retroactively appreciate it. Even if treating a patient whose mental illness has caused them to develop strong religious beliefs that cause them to oppose treatment (but still legally sane) medical ethicists hold that it wouldn't just be unwise but unethical to override that patient's own value judgement: even when that value judgement is to do something which they'll regret in the future.
Moreover, it wouldn't be ethical for a doctor to use coercive power they had over a patient to pressure them to accept. Sure, the doctor can try to persuade but they couldn't withhold some other needed medication unless the patient sees a psychiatrist who will try to convince them to take the drug they choose not to take, or to force them to get all sorts of other tests they don't wish to get to convince them they should follow the doctor's advice.
But yet when my ethics say that I care very much about not weighting the potential harms to myself over the benefits I'm told too bad we'll force you to do exactly that by creating a bunch of hurdles.
One thing that seems overlooked is that, even if it's ok to donate a kidney to a stranger (which is doubtful), it's definitely not ok to brag about it! I think bragging might be the greater ethical lapse here.
I suspect a lot of donors do it just to brag, or wouldn't do it if they couldn't brag about it. Certainly no one should donate if they wouldn't do it in a hypothetical world where it was impossible to brag about it - that makes motives very suspect.
The argument for bragging is that it might convince others to donate. It's unclear to me that this would be a good thing, but even if so, the harm to yourself and others from bragging far outweights any benefit from convincing others to donate.
How is bragging damaging to anyone? Let them brag, so that they may be encouraged to behave pro-socially on the expectation that they be granted bragging rights.
To be fair, I don't think Scott is bragging (he went off and did it without making a big announcement and fanfare, and only told us afterwards as much in part to explain why he hadn't been around as much).
Some people will brag, of course. But if they really went ahead and did it, then even if they want to be patted on the head for being supremely virtuous, they still come out on the debit side of the ledger. If they only talk about it but don't do it, or talk about why they would never do it not because they're squeamish or afraid of surgery etc. but because this is why it's more moral *not* to do it, then they do deserve a bucket of cold water over their head.
I frankly dont trust the medical field, from "protests from the right sort of people doesn't spread COVID", to the number one medical trade organization endorsing baby murder and the sterilization of mentally ill youth, to my constant contact with entitled Pre-Meds(I have been the lab instructor for several O-Chem classes), to the insane rules around around voluntary organ donation (tried to donate bone morrow; was denied for mild sleep apnea I'll literally be on a positive airway pressure during surgery) to historical grievances like doctors supporting of whatever "in" thing like coersive eugenics, to the fact that I still have to pay $150 a month for a simple stimulant prescription(not the medication which is another 300 dollars, when I can get it, but I won't blame doctors for that specific piece of DEA bullshit), despite taking this medication for almost 12 years, so I am very sympathetic to The Lone Ranger's argument, they obviously dont need organs because if they did they wouldnt have all these silly rules in place preventing people from donating.
Most of these things genuinely suck and I don't know how to solve them, but I think something's gone interestingly wrong in a possibly preventable way if you're paying $150 + $300 for stimulants. If you're in the US, the only stimulant I can imagine costing that much is Vyvanse, but it recently went off patent. Pharmacies are hoping you don't know this and trying to keep overcharging you, but you should be able to get it without insurance for ~$100/month at a local Rite-Aid or CVS if you use the GoodRx coupon, see https://www.goodrx.com/vyvanse . Sometimes pharmacies will refuse to honor the GoodRX coupons because "it's a controlled substance" - this is BS, but there's no good way around it, and you can solve this by going to a Costco or Walmart, where they usually have the fair price even without the coupon (although Costco sometimes saves stimulants for their members only during shortages, one of which is happening now). Let me know (scott@slatestarcodex.com) if there's some better way I can help with this, talking people through these processes is a big part of my job.
I also think your psychiatrist might be ripping you off if you're paying $150/month just to get the Vyvanse prescription. I would typically see a stable Vyvanse patient once every three months. A psych appointment ought to cost your insurance some amount, plus ~$45 copay. Unless you don't have insurance and are seeing a cash-only psychiatrist, that fee schedule doesn't make sense. So I think best practice would be for it to cost you $15/month (plus some extra amount for your insurance). Obviously none of this applies if there are no psychiatrists who take your insurance in your area or you don't have insurance, but it's probably semi-worth it to buy cheap ACA insurance just to take care of this problem, and "no psychiatrists have openings in your area" seems like a problem that shouldn't last 12 years. Let me know if you're in California and I will help you find someone less terrible than this; otherwise you're on your own. but now that there's telepsychiatry most people will find they have some options.
I don't think "they obviously don't need organs because if they did they wouldn't have all these rules in place" is a good argument. Sick people genuinely need organs, and medical bureaucrats have rules in place! There's no rule of incentives that says that if Group X really needs something, Group Y can't futz around making things hard for them for no reason!
Why should mentally ill people force their crappy genetics on someone else? They certainly will be horrible parents anyway, leaving their children or abusing them.
I hate my life and am mentally ill because of my useless father forcing me into this world (I grew up with a step father).
We need eugenics. Chris Langan has rightly defended it for decades. People don't care about their children anyway, killing or abandoning them. Were I not a Christian, I would kill myself immediately. In fact, were I not a Christian, I would forcibly sterilize the whole world. Who cares if you get sterilized, given how much sexual decadence exist today? Existing because your father and/or mother copulated with the n-th women or men just shows how meaningless our existence is and sexuality a curse by God which will not exist in Heaven, as Christ says Himself.
So stop this posturing please, ethics is a nonsense word for "morality" which has no basis outside religion, it cannot be defined by anyone but God.
I've been trying to work out why the original piece made me feel a little uneasy, when I rather admire what Scott and other donors do, as an act of straightforward selfless, kindness.....
And then it clicked. I think it's truly a fine thing to do. It is kind. Selfless. An act of grace. I'm not a christian but the christian tradition of valuing the gracious or even gratuitous act, a deed that may not be mandated by an ordinary moral code, is a very attractive concept.
EA at its worse sounds like a parody of utilitarianism. But its impulses are noble. Bernard Williams observed that utilitarianism thins out our moral language and thus thinking. Important distinct concepts such as love, honour, generosity, attention, grace (my partial list here, not his) get ignored or reduced, but these are central to long-standing notions of what it means to be a good person, of what it means to live well.
As I say, I admire the kidney donors. Perhaps Scott is too self-effacing to lay claim to the the virtues of what he has done but (to use another important word) it seems to me a noble thing.
Among the problems with arguments from optics is that how you look depends on who's looking. People who hate lawyers will look down on you for getting a law degree, but law offices will hire you for it. People who believe that murder is wrong will look down on you for it but it's a big bonus in the gang status ecosystem.
More relevantly for this example, some people will ALWAYS think you're weird or even evil for trying to change the status quo. Optimizing your optics for those people means abdicating all desire to make the world a better place. Choosing your altruism based on "actually doing good" means picking a form of optimism that signals seriousness and correct beliefs to a subset of altruists even if it means spurning many other causes.
Did no one comment from a markets standpoint? Legalizing the trade in live organs would solve a lot. Donors would get compensated for the risks (which don’t seem totally negligible and at least warrant further study) and their pain (just the word “catheter” is enough to ensure I would never do this except for a very well-behaved family member). As an added bonus, markets may even put a stop to the cringe moral preening of the donor class.
The last comment talked about the fear of a supposed organ mafia in Germany. At least in Brazil, this is a real fear many people have, especially after a real case happened (The Pavesi case) , which even makes them unlikely to allow post-mortum donation of their organs, so this might also occur in countries that share low trust of authorities.
Could one donate a kidney, feel good about it and then not tell anyone?
Yes, it seems technically possible.
Is there a breakdown on QALY for bone marrow donation vs. kidney donation? A friend of mine did a bone marrow donation, and he seemed to find it similarly transformative as an experience.
Fuck man, Scott did something quite amazingly altruistic that not even 0.1% of people actually do. Huge kudos to him, end of story. Altruism has been a thing since there is a humanity, and people have even found it even in birds and other critters. Why do people feel the need to create a huge controversy about it is beyond me. No one is asking *you* to do it, and I don't think anyone could actually argue that it's unethical. Scott gets the satisfaction of personally giving some lucky unknown a huge improvement in quality of life, and to exercise his 100% pure-American freedom. Win-win for all involved.
> You don’t kill your cattle on the full moon while chanting unless you’ve heard of other people doing that, but it might occur to someone to try to figure out how to do the most good even if they haven’t been brainwashed into trying. I’m more surprised that so few people find it to be an intuitively obvious goal.
I think this might be because most people (even if they won't agree to it plainly put) internalize "good" as a relative goal to themselves, their in-group, etc. An abstract goal of doing the most good implies that one can objectively measure a "good" that isn't your own self- and group-interest, since if you're working to the best goals you have for yourself already, that's just unremarkable.
>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?
It's the same reason some non-Vegans get mad at Vegans, and why smokers used to get mad at non-smokers.
If someone is doing something good hat you're not, it implicitly puts them above you in social hierarchy.
If a social norm comes into existence where lots and lots of people are doing a good thing that you're not doing and it seems normal to do that thing, you're suddenly actively being bad when you were just fine a moment ago.
People who don't intend to adhere to a newly forming social norm have an active interest in preventing that norm from forming, because it will be used to judge them in the future.
(Of course, this thought process is rarely explicit, and more commonly takes teh route of an ego-defense mechanism: 'People are trying to persuade everyone that doing X is good, but I'm a good person and I don't want to do X, X must be secretly bad for some reason and I should do the good thing and warn everyone against it')
I don't understand how Scott says he was there at the founding of EA - the founding of EA was with Peter Singer's famous 1972 essay "Famine, Affluence, and Morality" which was before Scott was born.
I assume publishing the book is not the same as starting a movement of people who change their lives according to the book.
For example, if tomorrow thousands of people start dressing like Harry Potter, the date of the "dressing like Harry Potter movement" would be tomorrow, not when the books were written.
When Singer wrote the essay, it didn't make people immediately pledge in mass to give 10% of their income to charity and research which charity is the optimal one. At first, for most people it was just another cool topic to discuss, without actually doing anything differently.
I hate writing critical comments other than in response to one or to rescue someone under critique.
Scott is the NICEST GUY. I never met him but I love him. I've recently had the good fortune to Zoom meet someone from this group and he's an amazing fellow. And most of what I've read from most people has been great too.
I have one bad experience with this group. It was early on in the hysteridemic and someone set up a Zoom or something. I was outdoors and recommending others live likewise and was mocked (behind my back of course, cowards gonna coward). But I was right and they were wrong.
So when I see a compadre's case getting stiffed in the main text I gotta come to his aid and point out that Scott missed the Lone Ranger but *shot the shit* out of his strawman.
Scott wasn't on that call and I'm certain that he would NOT have been like the rude (and oh so stupid) couple of snot-nosed know-nothings but he gave cover to The Scare and bears some of the responsibility for the impudent impunity with which his people acted to the one guy who was right.
Scott, with genuine respect, it seems that Lone Ranger doubts your medical evidence and you and the "rationalist community" generally when it comes to "socially good" medical matters.
I wasn't commenting then but I was reading, and you plus 90% of the people in this community were not only wrong but - ahead of the curve wrong - about Covid.
That jerkwad from the NYT who wanted to write a nice article about you and this community regarding how you "got covid right", did you a tremendous favor by totally ignoring your desire to not have your name revealed.
That killed the article that would have hung around your neck until the end of days.
I *LOVE* you, and I'm quite positive about nearly everyone in this community too but you were all Obviously And From The Start wrong-wrong-wrong and biased-biased-biased about Covid and there has never been a local "learning from our errors" in this space.
Or at least not one commensurate with the fact that this community was NOT uninfluential at that time.
This community and the many brainy indoor types that interact with it gave the kosher stamp of "smart serious men" approval to all the hysterics out there.
I don't know the numbers in kidney safety but dude has a point.
How many people here knowing lied or otherwise manipulated their words to get people to take the shot?
And that was waaaaayyyyyyyy down the line when everybody and their mother knew that "everybody would get Covid, it would kill the very medically compromised, and there's nothing we can do about any of it".
Oh, and that the shot was the placebo excuse for TPTB to call an official end to their hysterics without having to cede either fault or power.
I assume your numbers here are generally good so I won't dispute your claims about kidney donations, and in general I SUPPORT US ALL TAKING RESPONSIBILITY FOR EACH OTHER IN EVERY WAY.
But the shade he throws at your trustworthiness regarding matters medical that are within your understanding of "the moral good" isn't undeserved.
You're going to need to present evidence and links to specific disagreements if you want to be convincing to a rationalist. I would suggest either responding to the zvi's or putanumonit's take or a specific highly upvoted LW post
, because this is the type of drive by no (epistemic) effort disagreement that the community gets regularly, except this also happens in the opposite direction too.
Hi Scott - random IgA Nephropathy patient here. Your article made me cry in the good way. My life could depend on someone like you. Thanks for writing the article.
Reading the original essay really shocked me to my core. It feels so insane to give a part of your body to a random person you don't even know.
Why?
How about: maybe not everybody is equal? To me, Scott is worth more than a random person. He's even worth more than 10 random people. One more year of Scott will probably improve the world more than 100 years of random other people. So 1% chance of complications during surgery would not be worth 100% certainty of giving a person 40? (50? I don't know his age) more years to live.
I mean, isn't that the whole idea of EA? That you should think about how to most efficiently save people?
I think if you think that way and use it as a basis for action, you become a much worse person. Willingness to self-sacrifice is an admirable quality.
There's a lot of comments that are very bizzare to my own sense of morality. Maybe I'm just so Christian that I find it hard to comprehend people who assert that self-sacrifice is bad - not just not required, I understand that, but actually something that should be avoided and prevented? Sure, not everyone can be a saint, but apparently a lot more people agree with Randian objectivism than I would have thought?
To clarify, I'm pretty consequentialist when assessing right and wrong, but in order to have an actually usable defintion of morality I regard self-sacrifice for the sake of others as superegotory, not obligatory. Nobody is required to donate a kidney, I haven't done it so I'm in no position to criticise, but I still regard it as the right thing to do - in the same way that selling all you have to give it to the poor is the right thing to do, I just also haven't done that yet.
Anyway, I respect Scott more after this, and I'm glad he posted it because I think it may lead more people to do the same - not out of guilt, but out of a desire to better themselves/on-up other people, and isn't that what morality is all about?
I think the concern is that things stop being supererogatory when people actually start doing them regularly.
You not giving all your property to the poor is okay because no one around you actually does that. But imagine a world where dozen your friends already sold everything and donated the money to the poor... but you didn't. Wouldn't that make you seem like a bad Christian? I mean, if they all could do it, why can't *you*?
I can see why I might object to that, but that's only because I'm not a very good person, and I think that I might become a better person if people around me expected more of me. One of the ideas behind having an "EA Community" as opposed to just an EA Philosophy - or indeed, a Christian Community rather than just a Christian Philosophy - is that being part of the community places social pressure on you to do things like give away money (and I guess also kidneys now), it's a feature not a bug.
(As for whether this is the wrong reason to do this - I think people always have mixed motivations for even the most seemingly selfless acts, desire for social approval is a reasonable motivation as long as you're actually doing the right thing.)
Also, seem unlikely that regular kidney donations will ever be that common outside of a few weird subcultures, there are not that many people who need kidneys as a proportion of the population.
It seems that we have a somewhat paradoxical situation where good communities create more good but harm good people in the process, while bad communities create little good but allow good people to prosper.
Or maybe that's just a "valley of bad altruism". When few people are altruistic to the extreme, they have to sacrifice a lot. But if everyone shared the burden... for example, imagine if literally everyone on this planet was willing to donate a kidney -- only a few would actually have to. Scott would just sign up in some list of volunteers, but probably no one would ever call him, because there would be millions of other volunteers.
I found it puzzling that your original post there was a very strong argument that nobody paid any attention to, as far as I could tell:
> The procedure does increase your risk of kidney failure — but the average donor still has only a 1 to 2 percent chance of that happening. The vast majority of donors, 98 to 99 percent, don’t have kidney failure later on. And those who do get bumped up to the top of the waiting list due to their donation.
If properly fleshed out it has a potential to be an absolute killer: donating a kidney is like buying insurance against dying from kidney failure, so if you're concerned about it, and the numbers work out in your favor, you should, based on purely selfish logic.
But there's a problem, it looks like there are two kinds of people: some are deeply concerned about being Good, and donating a kidney provides them with a tangible evidence that they are in fact Good. This goes like a refrain through the original post and all the comments from people who donated.
The other kind of people don't feel this urge as strongly, and reading the above makes them feel that they are being shamed into it. Also they naturally suspect that deep down the altruistic people donate for status (and they could be partially right, even in case of people who only brag about being Provably Good in internet comments).
Of course most people are likely somewhere in the middle of this spectrum, but are pushed towards the ends by some sort of a cascade amplifying the initial kneejerk reaction, if your first thought happens to be oh shit here's a chance to do some good you will keep warming up to the idea, if it was that the donors appear awfully smug, you will invent reasons for why they have no moral authority.
But most interestingly this theory explains why being bumped to the top of the list of kidney receivers was soundly ignored. Because the pro-donation people, including yourself, are all of the first kind, and if it turns that donating a kidney is a *selfish* act then why, it means that your certificate of being a Good Person is not as good as you thought!
Therefore an *effective* way to convince people to donate kidneys might require writing two different posts aimed at these different audiences. One, investigating whether donating a kidney is a good insurance against dying while waiting for a kidney transplant and any other potential benefits you can find, and not mentioning anything about being a Good Person, and another, basically the one you did write, aimed at people who always wanted to donate for altruistic reasons but haven't realized that it's actually something they can go and get done.
"The multiphase abdominal CT used in kidney donation screening is 30 mSv"
For someone of your build, with modern scanners with automated tube current modulation, the dose would be closer to 10mSv. Here's a paper (It's 3-4 mSV per scan and 3 phases in the multiphase scan): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258803/
In the future with next generation photon counting scanners, radiation dose will go down another factor of 2-3 which should make this less of an issue.
Late reply but this would be my full argument against kidney donation: https://ontologi.cc/21e64798347049258c3c6d05f0d7a23f
tl;dr scott I think you got the science wrong, and are conveying the idea that a very damaging procedure isn't, and I think a lot of young people considering donation might be doing so without having thought through all the ethical implications and internal processes leading to this and potentially resulting from them.
I was thinking about my opposition to specifically monetary compensation for organ donation, and hit upon a solution which might actually be good - someone get the Catholic church or some other big religion to straight up confer sainthood onto organ donors. I think this is far less liable to abuse than paying people.
This seems to be the motive driving most EA altruistic donation, but that's secular, and a lot of people don't strongly identify with EA anyway. Enter: sainting.
Disadvantage: might make the average person who doesn't strongly identify with being/becoming a saint less likely to donate. I don't consider this a huge loss because I don't think they were likely donors to begin with.
Thinking about the fall-injury incentives thing from https://slatestarcodex.com/2016/11/10/book-review-house-of-god/ is it possible that somehow adjusting the basis on which medicaid and other government programs pay for dialysis would motivate existing medical providers to throw their weight behind reforms?
*Otherwise, I find it interesting that so many people feel protective of potential kidney donors and want to protect them from self-sacrifice... So what’s the psychological motive here?*
Fairness intuition. The median kind of person who would consider altruistic kidney donation is likely to be overly generous, overly giving and vulnerable to exploitation. No one likes to see a vulnerable or unusually generous person being exploited by free riders who’d never reciprocate.
Of course I don’t think Scott himself is particularly vulnerable to exploitation or manipulation; he thinks everything through too carefully for that. But if kidney donation were normalised, I expect a lot of overly kind people with low self esteem would pay the price. (The same people would be vulnerable in the event of euthanasia being normalised.) These people would be mostly female.
I’d never, ever do it myself for far too many reasons to list. But the reason I wouldn’t like it to be normalised is that it would inevitably result in a net transfer of health from females to males, and most women are already sacrificing their health for others in thousands of small and large ways that add up to a massive injustice.
Why should mentally ill people force their crappy genetics on someone else? They certainly will be horrible parents anyway, leaving their children or abusing them.
I hate my life and am mentally ill because of my useless father forcing me into this world (I grew up with a step father).
We need eugenics. Chris Langan has rightly defended it for decades. People don't care about their children anyway, killing or abandoning them. Were I not a Christian, I would kill myself immediately. In fact, were I not a Christian, I would forcibly sterilize the whole world. Who cares if you get sterilized, given how much sexual decadence exist today? Existing because your father and/or mother copulated with the n-th women or men just shows how meaningless our existence is and sexuality a curse by God which will not exist in Heaven, as Christ says Himself.
So stop this posturing please, ethics is a nonsense word for "morality" which has no basis outside religion, it cannot be defined by anyone but God.