"Second: doing a good thing so you’ll feel good about yourself doesn’t seem healthy. "
If you're just taking up space in the world and doing nothing for others, SHOULD you feel good about yourself? And I can understand having greater care for people you know and love, but could this not also be exploited as well? "I know knocking off Johnny makes you all squeamish, but it's for the family. You wouldn't chicken out on your family, would you?"
Those "others" you talk about helping - are they just sitting around taking up space in the world? Why do you feel good about helping people who are "just taking up space", and how is this the best possible use of your time.
Or, alternately, if the people you are trying to help are themselves trying to help other people, doesn't that at some point trade against everybody helping themselves and skipping the extra transaction costs? Particularly if the "everybody helping everybody" thing is pushed to the EA ideal of donating every marginal dollar, because by that point you've run out of low-hanging fruit on the "helping other people" front.
That just sounds like communal living. Everybody contributes, therefore nobody goes without, therefore nobody just takes up space unless they become physically incapacitated. But because it's understood that they would contribute if they could, and everybody is in the contributing habit anyway, it doesn't feel like a burden.
1) Scott knows that. Jeez, do yoou think that’s news? Donating a kidney and engaging in effective altruism are not mutually exclusive. He can engage just as energetically in EA with one kidney as with 2.
2) You don't quite get the feeling good thing. It's not feeling virtuous. It's not the ethical equivalent of feeling smart because you just got your LSAT score back and it's really high. It's an *emotion* you get from direct giving to a stranger. The first time I felt it was while I was in grad school. I signed up for one of those "give to the needy" Christmas things, mostly because I was bored. I was given the ages, clothing sizes and modest Christmas wish lists of the members of a family, and I went to the mall and bought all the stuff, plus a few items I thought could not fail to please — one was a baseball-sized Hershey kiss. Later, I felt unexpectedly emotional while wrapping everything — suddenly felt very loving towards these strangers. And for days afterwards I daydreamed about them opening the presents, and hoped they were happy with them. I yearned to watch them unwrap them (but to be invisible, so there were no weird awkward thank you’s.). It was definitely a good feeling, but it was not at all a kind of pride. The closest I can come is to say that it put me in touch with a loving side of myself that I did not know existed. It felt good to manifest that side. I do understand that this sort of direct giving is not an effective use of resources. The $100 or so I spent on presents could no doubt have been used much more effectively, produced much more total human benefit. But I think direct giving, while statistically ineffective, is a good spiritual practice for EAs and others. It puts you in touch with a side of you that wants to give more.
3) Are you aware that you can’t give a kidney to just anyone? You have to be a match on most of 6 (I think it’s 6) different variables — things like blood type. While family members are more likely to be matches , it’s far from a sure thing even for siblings and parents, who are the relatives you share the most genes with. With them there is I believe about a 50% chance that you will be a half-match (match on half the variables) which is decent but not great. Once you get to aunts and uncles and cousins, the chances drop pretty low. So let’s think about the numbers, as EA’s do. Scott is 38. He has 12 more years before he’s too old to be a desirable donor. He has 2 parents & I believe one sibling. Regarding kids, let’s think large and assume he will father 3. So he will have 6 relatives with whom there’s a decent but not great chance he’d be a match. And what are the chances one of them will need a kidney in the next 12 years? Just looked up what percent of population currently has end stage kidney disease. It’s about 1 person in 500. I'm sure the majority of them are adults, and half of Scott's 6 future relatives in our model will be children during the 12 years when he is young enough to donate. So overall it’s quite unlikely that one of Scott’s close relatives will need a transplant in the next few years, and even unlikelier that somebody will need one AND he will be a match. Given all that, does it make sense to hang on to his spare kidney on the off chance a close relative will need it in the next 12 years?
At least in Britain (? Not sure about country) they have a system where you can "trade" for optimal kidneys, where, say there's several donors with incompatible relatives with failing kidneys, and they keep getting matched up with another incompatible donor compatible receiver pair, until s eventually someone comes in and completes the chain, so then all the recipients get an appropriate kidney and all donors have donated.
I’d love to know if other women have considered this and have better info on the risk of being one kidney’d for future pregnancies. I know pregnancy taxes your kidneys more than ordinary life, and since I have a history of miscarriage I’ve been reluctant to add any new risks.
(I’m also curious if having one kidney means being risked out by eg a birthing center or a midwifery practice).
They did note some pregnancy-associated risk increase post-donation, such as a higher likelihood of fetal loss (19.2% vs. 11.3%), gestational diabetes (2.7% vs. 0.7%), gestational hypertension (5.7% vs. 0.6%), proteinuria (4.3% vs. 1.1%) and preeclampsia (5.5% vs. 0.8%). Also, a lower likelihood of full-term deliveries (73.7% vs. 84.6%).
These outcomes were more likely in people's post-donation pregnancies, than their pre-donation pregnancies. Sounds like they tried to model age in, but they admit that it is hard to be fully sure they factored out age effects. Kidney donation screening seems to have meant the pre-donation baseline started out at better than genpop, and they characterized the post-donation numbers as similar to genpop and lower than individuals with kidney disease? Looks like a risk-increase, though.
Now that I have two kids, I wouldn't actually do it.
One of my kids is disabled (autism) and even a tiny increased risk of death or shortened lifespan is too risky for me, because he's probably going to need life long support from me.
It's also reduced my donations to charity significantly for the same reason, I need to save all the money I can for after I die because he's unlikely to be able to have a job in the future.
In retrospect I should have skipped having kids entirely and done kidney donation instead, but hindsight is 20/20.
I am stoked about using IVF with embryo selection to select the embryos with the fewest risky variants and the fewest de novo mutations. Reducing the rates of de novo mutations and risky variants by 1SD each generation is a huge boon to health. In 50 years your kid's disability will be much rarer if regulators can get out of the way and let capitalism make it cheaper and more convenient.
"In 50 years your kid's disability will be much rarer if regulators can get out of the way and let capitalism make it cheaper and more convenient."
Even cheaper and more convenient if regulators get out of the way and just allow the crips and 'tards to be aborted, right? IVF etc. is expensive and time-consuming, just dump the failed attempt and try again, and if your genes are too mucked-up to produce healthy kids, stop trying to have kids. That's the sensible solution, yes?
Yes, and I say that unironically. I don't want to get into an abortion argument because those are tiresome and repetitive, but I'm curious about your counterargument to this: "if your genes are too mucked-up to produce healthy kids, stop trying to have kids"
What's wrong with people voluntarily choosing not to have kids to spare them horrible suffering?
Sure, if it's a disease that causes horrible suffering. I'm not sure even acute enough autism to need lifelong support inflicts "horrible suffering," to go back to the conversation starter.
We actually had both our kids fully sequenced and the polygenic score for autism is actually higher in my neurotypical kid than in my autistic one. At the current level of technology it's clear the power is just not there yet.
I remember talking to someone in this field a while ago who suggested that it is in fact still better to have natural conception if possible vs pre-screened IVF because of an inherent lower risk of mutations as seen in (some?) studies. I think this is something that people might want to look into before deciding to pursue genetic screening for embryos.
parental age (especially the father's age) is the biggest modifiable risk factor for de novo mutations. IVF users would tend to be older and sicker than natural conceptioners so it's probably just an artifact unless they explicitly controlled for that. But anyway they can just measure the number of DNMs in each embryo after the embryos are made and factor that into the choice of which embryos to use.
also the paternal age DNM problem could be completely avoided if dudes freeze sperm when they're 16. Providing that for free would be 100x worth it for a country with cradle to grave nationalized healthcare.
I remember looking into this before I donated my kidney, and the only risk that I recall there being solid evidence for was a slight increase in the risk of pre-eclampsia. That said, it's totally reasonable to wait until you're done having kids, especially if you've had problems in the past.
In the realm of anecdotes: I had an uncomplicated pregnancy and now I have a beautiful, healthy one-month-old!
Out of curiosity did you donate your kidney to a stranger like Scott did?
My guess would be that "donating your kidney without a known recipient" falls in to the category of things that males are far more likely to do than females.
Obviously my theory is untestable if indeed there are greater risks for women (either for their bodily health or reproductive health), but simply based on my limited knowledge of male and female psychology I would imagine that (unless it became the social norm or otherwise "cool") the number of men donating kidneys to unknown participants compared to the number of women donating kidneys to unknown participants would be at least 5 to 1.
Like I said though, if indeed there are greater risks to women then my theory can be proven wrong (if indeed there is greater parity than 5 to 1) but can't be proven right (because rational concerns wouldn't be gender equivalent).
I did donate my kidney to a stranger, actually. Let this be a lesson to you about making assumptions about people based on their gender, especially when those people are rationalists.
Hey, I hedged every which way to Sunday! 😂 Hell, my comment was even an attempt to CALL FOR MY CORRECTION!
Let that be a lesson to YOU about making assumptions about a stranger. 😉
I am 100% certain that what I did was as close to truth-seeking and overcoming bias as is possible to one of flesh and blood.
All that said, text fails to convey... pretty much everything. So let me say that I'm writing this with a sly smirk on my face as a friend joshing you because I'm reading your comment as coming from the same intent.
If you're serious though, I'd be glad to have an octagon death match of unbiasedness. We could make a youtube video attempting to uncover each other's irrationalities. Uncovering my own bias is like my favorite thing!
All that said, A. I still assume that the numbers are 5:1 in cultures where it isn't considered within the bounds of normalcy (it amazes me to learn that there's a community where it IS considered normal! and B. Bravo!!!!! 👏👏👏❣️❣️❣️❣️❣️❣️❣️❣️❣️❣️ A thousand or million times bravo What you did is absolutely amazing. You are a wonderful beautiful person. As a human on this planet I *personally* thank you for contributing to us and wish you snd your family every single happiness. Really, may there be more people like you. 🙏
If I could live my life over again, I'd donate a kidney at age 20-25 —i.e., old enough to be an Official Adult but too young to have kids. That seems like a good option for women who intend to have kids, to balance out the risks of potential pregnancy which will probably happen at 25-40 and the risk of an aging kidney being less useful.
I (25F) donated this year (also at Weill Cornell!), and my personal calculation was that because I'm already at very low risk of pre-eclampsia due to various factors, I could stomach being at slightly higher risk. My medical team told me that if/when I get pregnant, the pregnancy will automatically be treated as a higher-risk pregnancy, and appropriate precautions will be taken. That being said, I've never been pregnant, so my "calculations" were based on vibes. I also figured it would be much, much easier logistically to donate before I had kids than after. Also - I personally would be fully open to adoption in the event I was unable to have kids biologically, so for me personally it didn't necessarily feel like any of my options were being taken away.
Other than in the immediate hours after donating, when I was in a good deal of pain (and until I heard that the transplant had gone well and my recipient was recovering, which, like Scott said, put things into perspective), I have not regretted my donation for a moment. It is in all likelihood the greatest thing I'll do with my life (in an optimistic way!).
Thank you for donating, and that's a very helpful comment! I have sought out practices (midwives, birthing centers) that take an aggressive approach to "risking out" patients and banning them. Attempting a VBAC got me risked out from a group of birthing center midwives and accepted by a group of hospital midwives (it worked!).
To me, this suggests that it's not a good idea for women to donate a kidney if they suspect they'd strongly like to try home births, birthing center births, low intervention births and the lack of a kidney means they'll be risked out of compatible practices.
I'm more confident the increase in risk would lead to being dropped by those practitioners than that it *should.* But it's rare enough that I suspect many will not be up to consider the risk and run the numbers but will simple say "that's non-standard risk and we don't do it."
As a post pregnancy x2 woman, I would advise waiting until you have had children. There are just so many surprising changes to one's body during and following pregnancy that if healthy offspring with a healthy mom are your priority, holding off on adding an additional possible complication seems wise.
I think I'd have been very excited about donating a spare kidney when my kids were elementary school age if that had been at all a thing I knew about and if I'd been in a different relationship (my husband so objected to my donating blood that I stopped, even though I'd been doing it with no noticeable problems for 15 years, and went back to donating after we separated, again with no problems).
I believe that bodily integrity has a value in and of itself, independent of any utilitarian calculation around whether you will need a particular organ. (I don't mean "integrity" in some metaphorical sense. I mean it in the literal sense of keeping the physical phenotype in accord with its basic genotypic design.) Obviously, there will be a thousand and one exceptions in practice. (Fair warning: if you respond by giving me examples of such exceptions, I will be extremely unimpressed.) Every time one gives oneself a paper cut, one is violating bodily integrity in some small way. Of course. But I try not to do that on purpose, except perhaps to treat some greater medical ailment.
If you insist on utilitarianism, I suppose you could justify my position with some kind of rule-utilitarianism as opposed to act-utilitarianism. But I'm not a utilitarian at all.
I guess I don't understand what it means to assert a strange moral rule that there's no a priori reason to expect, admit that there are many exceptions where it's not true and you can't explain why, then continue to assert that it's a moral rule rather than a heuristic.
A: "I went to the park yesterday"
B: "What? You should never go to things beginning with P!"
A: "But don't people go to the port and the parlor and the palace all the time? And you never object to that?"
B: "Yes, obviously there are a thousand and one exceptions in practice. But you shouldn't go to the park. That's just how moral law works."
I don't know how you could possibly argue with B at this point, it just doesn't seem like there's any positive reason to believe him.
Keep your bodily integrity, if you must, and celebrate those who save lives in real time in the real world! If Sam bankman Fried just gave a body part instead of his soul, we’d all be better off
Is "keep one's body intact" really a "strange moral rule?"
Your story about "not going to places that begin with P" is the kind of story I'd expect a utilitarian to tell. And yet, "keep my body intact" doesn't seem anything at all to me like "don't go to places that begin with P."
Why might that be? Perhaps the utilitarian stories are constructed –– designed? –– to filter out consideration of factors that cannot easily be verbally articulated and weighed for calculation, on the assumption –– undemonstrated and dubious! –– that such factors must be unimportant. But it seems to me that such factors, especially in regard to matters of the body, sex, and relations, might be very important indeed.
To ward off annoying evangelical utilitarians, you just tell them that you have a utility function different from theirs (I think that's actually just true, even if you reject the label, but I might be using the term idiosyncratically). They ought to know they can't argue with that.
You're right –– but only in the trivial sense that any norm can be reproduced by sculpting a custom utility function for it. I understand that, but consider it an unhelpful exercise.
Yeah, I agree: I don't think it's a useful exercise either. It's just that "utilitarianism" is as meaningful a name of the doctrine as "do-the-right-thing-ism," when it usually means something like "maximize-the-total-global-QALYs-ism" which doesn't correspond very closely to mine. (The alternative doctrines that try to describe themselves without reference to to utility functions strike me as either incoherent or downright evil, so this kind of trivial description is the best I've got. The detail is then in WHAT my utility function is, loyalty, honor, duty, etc.)
That's one of many reasons I don't consider myself a utilitarian. You can game the system to come up with any outcome you want, and it gives you the freedom to justify that. SBF probably still feels justified, even with the outright fraud.
If you posit that there are more utils in murdering people, you can justify that too. Maybe you're the Punisher, killing the worst people that the law can't handle. Or you've done the math and some people's lives just aren't worth living, so it's worth the hit to your utils to save them.
I'm a deontologist, so I just say that murder is wrong.
I think the example of SBF has been too quickly and too defensively bracketed. ("Oh, it turned out that he was just a fraud, not a *real* EA." Hmm, not a true Scotsman, you mean?)
My reading of SBF is that he was sincere, in the sense of sincerely following his Maximum Expected Utility, as he calculated it, and that led him to disregard ethical norms that did not accord with the latter.
In fact, AND THIS IS THE CRUCIAL BIT, like Scott, he would have demanded that those ethical norms be justified in terms of Maximum Expected Utility, and then dismissed them as "strange" when they were not.
In Sweden, we have a huge problem with "people the law can't handle," and a fair share of the populace is ready to applaud any such Punisher killing them off in the name of total utility. If so, we'll see where that takes us (Nazi Germany or El Salvador?). However, it will have to be compared to where we're heading now (probably Mexico).
Deontologically self-imposed limitations might eventually face ethical opportunity costs that make you want to reconsider them. Then the cultural evolutionary selection processes will undergo some learning that includes selecting away the principled. This is not a normative point but a descriptive one.
Any one person's ethical stance will, of course, be that particular individual's decision. The bigger issue is what norm will prevail, under what circumstances.
There's a complexity about that which is about comparison of utility between people and aggregation of utility across populations.
Most kinds of utilitarianism say that you should aspire to maximize total or average utility (or some variant of those meant to address paradoxes and counterintuitive results), of "everyone". In that case your different utility function would mean that *your personal contribution* to total (or average or whatever) global utility would be weird or hard to predict, but that doesn't change the utilitarian goal of trying to maximize something globally, nor the utilitarian moral intuition that *you, too* should being trying to maximize something globally!
(There's a whole set of criticisms of utilitarianism based on the conceptual difficulties of how to compare or aggregate utilities between different subjects-of-experience.)
A more considering stance would recognize that humans don't have complete degrees of freedom in their divergence in values, and so while there can be a legitimate underlying value difference, it can be exacerbated beyond the value it would have on reflection! So it can still be worthwhile to talk over it.
"I want to keep my body intact because it feels right to me" is perfectly fine and unsurprising.
"As a moral rule, one ought to keep one's body intact" is weird as hell and you haven't even made an attempt to justify it. The only way I could even imagine making an attempt to justify it would be through some form of divine command theory... but if you think you have a decent justification, I'm all ears.
Exactly. My first thought was of the now-defunct proscription in the Catholic Church against cremation and the revulsion of Catholic parents at the thought of ear-piercing or any other body modification. The point was that Christ was going to want to resurrect your whole body on Judgment Day. That was their strong argument for keeping one's body intact. It's a belief, nothing more. OK for you if that's how you feel, but not compelling to anyone who doesn't share that feeling/belief.
> Perhaps the utilitarian stories are constructed –– designed? –– to filter out consideration of factors that cannot easily be verbally articulated and weighed for calculation, on the assumption –– undemonstrated and dubious! –– that such factors must be unimportant.
There's a bunch of posts on the EffectiveAltruism forum and LessWrong about considerations like these, acting like EA is just naive utilitarianism is just a strawman imo.
You can infact have a higher value for bodily integrity than others! It just does actually seem like an odd value to settle on, especially when its qualified with a bunch of exceptions, which is what Scott is getting at. This is still compatible with consequentialism, and would just mean that you have a higher personal-cost for certain kidney operations.
I agree that having my body altered is significant, but that's primarily due to a combination of the unpleasantness, cost, and the possible problems that come from it (Scott's description of how the surgery before and after made my mind rate the cost for donating a kidney higher than I thought it was from vague thoughts before the post). But also, while it would be very uncomfortable to get a cybernetic eye that works better than human eyes (once we have them), I'd still be very interested to get them. It would just be worth the cost.
I think what Scott is getting at is that your form of bodily integrity value is an odd sort of rule, that makes less sense than other rules that are common (such as do not lie, do not murder). It makes sense as something to prefer, but doesn't make sense as something that tries to be set down as a law like 'do not lie' often tries to be.
"Keeping one's body 'intact' has intrinsic rather than instrumental value", which was what you said originally (slightly paphrased but I don't think misrepresented), does seem a bit strange, yes. Granted, the word "intact" has positive connotations, typically if asked if I'd prefer thing x to be intact, I'll say yes for most xes I care about. But when you try to figure out what the nice-sounding-thing "keep your body intact" means in practice, there's plenty of room for disagreement about what it should mean and whether it would be good.
If the meaning you intend by "keep your body intact" doesn't ground out in it being functional and healthy (which a body can be after an organ donation, in the same way as it can be after things I imagine you were thinking of as silly counter-examples, like hair loss and clipping your nails), and doesn't draw the line between an intact body and say a broken or improperly divided one in a way that recognizes the value of being able to function well, then I think whatever your definition of intactness/integrity is is likely on the wrong track, and would be strange to treat as a moral good. Also, if your values of bodily-intactness are selfish and don't recognize the goodness of giving something of your own body to help someone else's body function well and be more intact than it was (if, in other words, you wouldn't endorse trading a little of your body's intactness to help someone else a lot with theirs), then, I mean, ok, that's what you think is good. Seems strange and unconvincing to me.
If, however, you define bodily intactness with reference to bodies with parts that function well together, recognizing the physical fact that we're all ships of theseus, and if you are willing to agree that more people with intact bodies is better, and giving a bit of your body that makes you only very marginally less "intact" than you were to someone so theirs can be more intact, would be a good and generous act because of the effects on bodily intactness, then there really isn't a disagreement here, just a confusion in use of words. But it seems like you think organ donation would be bad by your moral values because it means you're no longer intact, so there is ovbiously some more substantive disagreement here, I guess.
I would agree with him that keeping your body intact has intrinsic value. That doesn't mean there aren't other values - helping others is another value. That does mean there is a trade-off, and you lose something above and beyond the inconvenience and pain and risk of complications.
OK, that's fine, I suppose. I am a left leg below knee amputee, so on thinking about this more it occurs to me that it is possible that my sense of whether and why bodily intactness matters relies less on intuition and more on explicitly thinking about my situation than most people :D. And so thinking that intactness matters might be something that a lot of people think, and I just don't, unless there's an impact on functionality, and it seemed strange to me because I'm just different. But actually, if we're just talking about intuitions about what is valuable, I can also see why "don't remove bits of me" is a fairly good heuristic generally, and this was emphatically more true before modern medicine. Sometimes the modern environment means our intuitions about what is good, formed in a very different environment, can lead us astray.
Shorter and more to the point than my earlier post: valuing keeping one's body intact as an intrinsic good absent any reference to its function and health would be a strange moral rule, yes.
Valuing an intact body because of how it's functional when intact is not strange, but it is also not incompatible with organ donation.
The fact that you find organ donation goes against your moral value of intactness, strongly suggests you place a strange value on keeping yourself "intact" even when you don't need to for health and function. One wonders what other things you might object to on grounds of bodily integrity.
I mean... keeping the phenotype in accord with the genotype's design? First off, your genotype wasn't designed. But secondly, why do you care about that? Would you care about that even in the case where your genotype included Huntington's or some other thing that made your life bad? If you had the gene for increased risk of breast cancer, would you object to surgical intervention, in that the integrity-respecting thing to do is die of breast cancer?
Unless your "integrity" value grounds out in a healthy and functioning body, then yes, it would be strange.
I kind of agree with SA that your point here is put pretty weirdly, but I want to draw attention instead to this weird tactic you are using of only contrasting your theory with utilitarianism. "It is intrinsically good to keep your body intact" is a specific rule, "utilitarianism" is a specific theory. It is true that utilitarianism does not include this rule, but you can't defend this specific rule by contrasting it to one specific unpopular theory. Lots of non-utilitarians will also find this rule unpersuasive, you are setting yourself up for too easy a job by shrugging at disagreement and going "I guess the utilitarians are at it again". It's fine if you don't have some specific justification you can give, lots of people bottom out parts of morality in basic moral intuitions, but you should, in that case, admit that you are losing anyone who does not share your intuition, not merely anyone who is a utilitarian (and of course if you do have some more basic foundation, you should give that rather than just picking on the utilitarians).
The "strange moral rule"s you're talking about are usually things backed up strongly by moral intuitions. You know, those things that everyone recognises but that utilitarians seem to make a herculean effort to pretend don't exist. They're certainly not remotely arbitrary rules.
One may not share those moral intuitions for particular Rules, but they're invariably held far, far more widely than the intuitions for many of the things utilitarians advocate. Deontological theories at their worst tell you to rigidly follow a principle even if it's unnecessary, like suffering for charity or whatever. Utilitarianism at its worst literally tells you to execute innocent scapegoats to appease a mob.
That's just one of a half dozen crippling problems for utilitarianism (where it gives not just a non-moral answer, but the anti-moral answer). Another crippling problem: it's pretty clear, and all commenters agree, that you, Scott, did a really great, heroic thing. And you did. Yet under utilitarianism, you just did the bare minimum you're obligated to, and in fact fell far short of that if you're not living in a cardboard box and donating everything you don't literally need to survive. And you apparently don't deserve any praise at all.
The fact that commenters are praising you, while some of them also defend utilitarianism, only shows they're at the common stage where they either haven't noticed, or aren't yet willing to face, the contradictions in their religion.
You're greatly overestimating how many people here subscribe to the sort of pure utilitarianism you're describing. Plus Scott and anyone else who's read the sequences is unlikely to be that sort of utilitarian, by virtue of how the sequences focuses on the ways overly simplistic moral theories lead to abhorrent consequences if actually taken to their logical extremes.
>Deontological theories at their worst tell you to rigidly follow a principle even if it's unnecessary, like suffering for charity or whatever.
Do you seriously not know the basic textbook criticisms of deontology? Like how a universal prohibition on lying when put up against a tyrannical government, forces you to not lie about hiding dissidents in your basement?
1. I was a bit reluctant to turn a celebration of Scott doing a good deed into an argument about utilitarianism. But this is the first EA/utilitatianism-related post for a long time, so I'm doing that. I'm in awe of Scott's principled and compassionate greatness though.
2. I am just a bit sick of something in this community that may not be an actual motte-and-bailey, but functions a bit like one. When asked or challenged, most people here disavow utilitarianism in its pure or even substantial form. And then, when no one's challenging it, many of them fall back into talking as though it's obviously true, obviously uncontroversial, and then some indeed get very angry at the existence of people who criticise or oppose Effective Altruism. This part *is* a basic motte-and-bailey: when challenged EA is merely giving more effectively, when not challenged it's full-throated utilitarian dogma (at least for some people). It's also depressing when a charity discussion comes up and I think "finally something everyone can agree is good, and come together on", and then people start talking about giving to AI-risk or making the sigularity happen faster or some shit like that. Much like a Christian charity spending a bit on distributing food and a lot more on distributing bibles, or worse actually because the latter probably brings *some* benefit to real people who actually exist.
3. I find the "sequences" to be some of the most simplistic philosophy I've ever seen (among consciously attempted philosophical writing). I also find a lot of it's terribly written (bad and unclear argumentative structure, even occasional bad grammar). I can't for the life of me understand its popularity around here, but I guess that's a whole other discussion. I certainly can't see what substantive insight people get out of it
4. That objection is to Kantianism specifically, not deonology generally. The major advantage of deontological theories is there are so many of them (Kantian fairness-based theories, rights-based theories, contractualist theories), and each form itself is very flexible and debateable, allowing them be molded to actually fit common moral intuitions instead of violating them. The lying example is Kant's own interpretation of his theory, but it could be interpreted differently depending on how you understand the "maxim" you are following in that particular axe-murderer edge case, and to what cases it's precisely universalised.
In any case I'm not saying other moral theories don't have problems, but I think utilitarianism has far more of them, and they seem to be often ignored when not being directly challenged.
"If you find mistakes, feel free to point them out."
I plan to do so (to some extent) in an open thread at some point. It's a big discussion.
The "simplicity" I'm talking about is mostly the writing style, not the arguments. Really, I find that there mostly are no arguments, or at least not clear and explicit ones. Maybe I haven't read enough of it or I'm misremembering what I have read, but my impression is that it's generally either all-over-the-place rambling (leaving me thinking "what the hell are you trying to say? could you be so helpful as to write out your conclusion, and preferably your reasons too, in clear sentences?") or asserting as "obvious" significant and very much non-obvious philosophical claims about reality.*
But its popularity around here (especially among fans of such well-written, lucid and clearly argued writing as Scott's) makes me wonder if I'm missing something.
"Heh, I can't understand the popularity of Hegel's Logic, and yet. Different people have different preferences, I guess."
And most Continental Philosophy has the same problem: very rambling and unclearly written, and seemingly deliberately so. I think the 19th century German stuff (Hegel, Nietzsche) isn't *as* bad as the 20th century French, but on the whole both it and stuff by EY seem to have an ideological objection to clearly laying out their arguments.
*As a general example that I'm not sure was said by EY in so many words, but that comes across to me strongly in his writing: we obviously can't learn anything about reality by just thinking about it. Or, with a circular argument instead of no argument: the reason we know you can't learn about reality by thinking, is that if you're just thinking you're not testing your observations out in the world, and obviously that's the only way to learn about reality.
The reason we know empiricism is true, is that obviously empiricism is true.
It sounds like your perception of a motte and bailey is partly you lumping together people with very different levels of sophistication in their views.
I think the most serious rationalists who've put much thought into moral philosophy and read the sequences tend to be moral antirealists.
You're somewhat conflating between people who are just naive utilitarians who almost certainly haven't read the sequences, and people who view moral philosophy as primarily useful for guiding your moral views towards internal consistency.
Though people also often confuse things with very non standard conceptions of utilitarianism: like the idea that if you can rank the desirability of potential worlds in a non-circular manner then that constitutes a utility function.
>and then people start talking about giving to AI-risk or making the sigularity happen faster or some shit like that.
You're confusing moral philosophy with epistemology here. If you think AI is liable to change the world dramatically in one's own lifetime, then that will necessarily inform your behavior under any nearly any moral framework.
> And you apparently don't deserve any praise at all. The fact that commenters are praising you, while some of them also defend utilitarianism, only shows they're at the common stage where they either haven't noticed, or aren't yet willing to face, the contradictions in their religion.
On the contrary, you're the one who isn't quite grokking utilitarianism here. You're trying to graft a non-consequentialist account of moral desert to a consequentialist account of moral obligation: of course it's not going to make sense.
Utilitarianism does not say that only saints deserve praise; it has no special rules for issuing praise or blame at all. They're just ordinary actions, subject to the same imperative as any other. If the consequences of praising someone are good, do it. If they're not, don't.
Yes, that's my exact problem. It's blindingly clear to most people, as a matter of basic moral sense, that people who do good deserve praise and people who do evil deserve punishment. Utilitarianism says that if someone does a great deed, but by shaming them instead of praising them you could make them do even more good deeds, then shame them! And if someone horrifically murders ten people but you have good reason to think he won't murder anyone else, unless you anger him by punishing him, then let him go unpunished! Both of these are grossly offensive to what morality actually *is*, as we have a sense of it.
It also implies that among the people praising Scott, those who are utilitarians don't actually mean it and are just speaking strategically to manipulate others to act. Which is a nasty thought.
> Utilitarianism says that if someone does a great deed, but by shaming them instead of praising them you could make them do even more good deeds, then shame them! And if someone horrifically murders ten people but you have good reason to think he won't murder anyone else, unless you anger him by punishing him, then let him go unpunished!
Sure, naive utilitarianism.
But a proper discussion would include costs like 'it is often better to provide positive incentives' + 'being truthful is a good'.
... but also if the benefit was high enough, I would shame them. I don't have a hard rule that I won't do that. However shaming tends to generate a terrible culture that feeds on itself and/or self-flagellates enough to be damaging. It is also hard to evaluate whether that would really be better.
And for the murderer, you have the issue that you want to disincentivize murders. I'm pretty sure Scott has a post on this, but I failed to find it. If you strictly thought about the direct impacts of your choice, then if you let him go free then the murderer lives a decent life, but if you put him in prison then someone lives a bad life (ignoring that you imply he'd murder again). So you release him.
If you consistently follow this rule, then you've essentially given a Get Out of Jail Free card to anyone who can commit a bunch of murders (or other negative crimes), gets caught, and then can say they'll never do it again.
The proper analysis of this would be that you need to provide a disincentive. If you murder someone we throw you in jail. This makes so people are less likely to commit murder or stealing or whatever because they know they're likely to personally gain less from it.
This is similar to the analysis that some people give for the classic 'Doctor could save five lives by taking the organs of this one mostly-healthy person'. If you expect that an institution people can legibly trust (predict) to heal them and not do anything else would then help more people, than it is better than the alternative institution where you have to worry about getting your organs harvested and so you're less likely to go in because you broke your leg.
These do become deontology-like, but that's because I agree that deontology captures some ideas of our moral rules! However, I think that the utilitarian analysis lets you decide when it is reasonable to break them or shift them - if you do a proper analysis, which is hard! I see rules like 'Doctors will not harm their patients' as useful ways to be legibly trustworthy and reliable. The punishment of law is also about disincentivizing it from occurring in the first place.
As well, utilitarianism/consequentialism doesn't stop you from inherently wanting to punish others,
I don't really understand what you mean in that last paragraph. If some person praises Scott in order to manipulate (persuade) other people to do the same thing as Scott, what does it mean that this person might not "actually mean it"? If she is a utilitarian, she is doing that manipulation because she thinks that Scott did something that was a net good.
Do you mean that she needs to feel emotionally that Scott is to be praised, in addition to just calculating that donating a kidney is a net good? Like, she has to be emotionally sincere?
I've come to think I was too snarky and aggressive in the above comments, trying to simplistically refute utilitarianism, when other moral theories do indeed have problems too and there's a clear balancing act required. And utilitarians (especially those like Scott) are actually doing good in the world so who am I to oppose them?
What I do stand by is my point above that some utilitarians, including some commenters here, not only take it completely for granted but react with disbelief or worse that anyone could not be a utilitarian. I thnk *those* people specifically need to have all the many problems with utilitarianism shoved in their faces when they exhibit that attitude. But most probably aren't like that.
As for your question, I think what I was getting at was that if someone expresses praise for a deed, that should *necessarily* correlate with her thinking that deed was good. At least in theory, a utilitarian acts and speaks only to maximise good outcomes (not truth per se), and thus you can never be sure if she's speaking truthfully. But you make a good point that in the case of praise, the outcome and the truth are likely correlated. So my objection was perhaps not very coherent.
One hard case is whether you should let dictators have comfortable retirements or punish them if you can.
Maybe letting dictators have comfortable retirements will get more dictators to retire. Maybe punishing them will make them hang onto power as hard as they can. (Actually, no maybe for that one.)
But maybe punishing them discourages other people from becoming dictators.
There are so few dictators and the circumstances under which any dictator comes to power and leaves power are so unique, and dictators by definition change or subvert the entire system including any precedents or previous incentives.
Also people who become dictators already know that they're risking death if they ever get deposed and know not to trust any promises of a comfortable retirement.
I had LASIK to treat myopia, which was a phenotype caused by my genotype.
Genetics certainly play a role in obesity, and I wouldn't bet against genetic predispositions towards torn ACLs (or at least predispositions towards the foolhardy things we do to tear them).
I got evaluated for LASIK. (Sadly, I turned out not to be a good candidate.) LASIK pretty straightforwardly restores a normal function (seeing). It doesn't impinge on bodily integrity in the functional sense I have in mind.
Sure, it ablates tissue at the micro level. You can press that point if you like, but I'll consider it a kind of quibbling that doesn't interact with my actual position. Ditto with similar examples of medical repairs.
It seems to me that the principle you believe in is not really bodily integrity (because there are so many exceptions you accept), but something like "a person has an obligation not to damage his or her body's functioning".
Piercings, tattoos, circumcision, sterilization/vasectomy, hormonal contraception, abortion, breast implants/reconstruction, cosmetic surgery, sex reassignment surgery, anabolic steroids -- what is your opinion of these?
Does donating a kidney to a spouse or a relative also violate your principle?
Integrity and function are closely linked: removing an otherwise functioning organ is usually a sure way of impairing or destroying its function.
It's not really that I accept "exceptions" to damaging integrity as if they were special carve-outs. It's just that many such things are trivial (e.g., donating blood that will soon be renewed) or done precisely to restore function (e.g., LASIK or similar reparative procedures). I don't really view such things, properly understood, as "exceptions" at all.
I definitely disagree here. I share your view that bodily integrity has some intrinsic value, but I intuitively feel that LASIK violates that, which is why I would never get it.
LASIK is not so straighforward. It's a risky and experimental procedure, in that we still don't know the long-term effects of it. LASIK "restores function" (in some cases) by destroying tissue in ways that weaken the eye and the body as a whole, and there are just too many horror stories and too many risks for it to be justified.
In my view, this is not a coincidence or a flaw that can be corrected by a better procedure, but rather an inevitable effect of anything that harms bodily integrity.
You may well know more about LASIK than I do. If we have a difference here, I suspect it's about the facts of what LASIK does, not about the ethical principles to be applied.
So does a kidney transplant! Not saying that you should value other people's bodily integity as highly as your own, but presumably it should factor into your decisions if it is indeed something of value? I'm not saying anyone should do it, I'm still pondering it myself, but we come back to weighing up the loss to you (both definite and potential) against the gain to others.
If you don’t care whether others do it, and just regard organ donation as too risky/dangerous to consider for yourself, isn’t that just a matter of personal risk tolerance? Or would you advocate for shutting down voluntarily organ donation programs and the like, and enforcing strict restrictions on various surgical procedures?
I personally have very low risk tolerance for surgery (ex/ avoiding LASIK) but don’t think there’s a generalizable *moral* principle there.
The justification is that he doesn't want to donate his kidney but he also wants to continue feeling morally superior.
There's nothing terrible about not wanting to donate. I'm not planning on doing it. But trying to tear down people who do an obviously altruistic thing is very weak in my opinion.
No, that’s your hypothesis as to his actual motivation. Which may or may not be correct, but the principle of charity would seem to indicate that we should give him the chance to explain himself first.
There's something very interesting going on with this section of the concept space. I can't quite puzzle it out. It's worthy of further consideration, but perhaps of a style better suited to Sam Kriss than Scott Alexander.
When it comes to morality, my experience has been that almost everyone including me decides what they think/feel is right, and then finds a rationalization. They know the answer they want to get before trying to think it through logically, and logic is then used to justify the felt-correct conclusion. If a particular logical argument is shown to have a hole, another will be found, but the conclusion won't change, unless it is shown that two moral values are in conflict. Before I was aware of this happening to me, it happened 100% of the time. Now I aim for a lower number, like 90% :)
Considering the idea that organ donation might be bad because of "bodily integrity" is going to be hard for people who have read Scott's post and decided that what he did was very good.
Similarly, I expect that you feel some negative feeling (I'm not you so I won't try to describe your internal feelings in detail) around some of your organs not being in you any more - it feels wrong for that to happen, and all your inside-bits being inside you seems straightforwardly right, and logical consideration of whether "bodily integrity" is a coherent concept on which to base a moral view is informed by the fact that yes, obviously your inside-bits should be inside you, that's not really up for debate.
I've tried to make logical arguments in favour of organ donation and against an overly restrictive definition of bodily integrity that would forbid it, while allowing a less restrictive definition so you can have your core intuition respected, but I don't expect that to like, work. :D
I don't feel negatively toward Scott or his decision on a personal level. I assume his decision was motivated by subjectively positive feelings, just as he mentions in the post. I see part of the value of norms being that they help guide decision-making independently of such feelings.
What "norm" are you advocating for here, exactly, and why? Based on what I've read you post here, I am genuinely unsure. It seems like different things in different places.
At first I thought it was something like "keep the bits of you together, and don't pierce your skin, although little cuts like a papercut are OK, and there are other exceptions which are obvious to me and I will be unimpressed if you bring them up" (if I was to put it in simple terms as best I can). But then you said something along the lines of "let your genes express themselves", and then "be like a normal human". The last two things seem to be getting further and further away from what I've heard anyone else call "bodily integrity", and to contradict each other if you have rare genes.
Feel free to disregard what I thought you meant and just say what you actually mean, and why you think the norm you are advocating for is good.
I agree with your basic premise, but would phrase it slightly differently. I think that moral facts are experienced by intuition and emotion.
We can try to come up with logical explanations, or theories, that try to take all these moral facts and explain them, but no one has ever done this in a satisfactory way.
So, no, your conclusion should not change because someone pokes a hole in the theory you make up to try to explain it. The conclusion is a moral fact - it is what needs to be explained, and if the theory is unsatisfactory or defective, you need a new theory to explain it.
Hmmm.... depending on what you mean by "moral facts", I may or may not agree that such things exist. I view the moral emotions such as guilt and moral outrage and the desire to punish offenders and reward good behaviour, as, well, emotions. Although certainly they're socially useful emotions which help us operate more effectively in groups, not just random things we feel. And the rules we make up when we operate in a social setting must take account of those emotions, because otherwise nobody will buy into the rules. But sometimes, moral reactions can cloud our thinking, and if we were thinking from a more dispassionate perspective about the situation, we might take actions that our future selves (who have gotten some distance from the situation we're reacting to) would think are better. For example, what seems clearly fair and right in an almost-factual "this is how reality is" sort of sense, right after you have been wronged, might seem unkind and unfairly harsh and unwilling to take into account factors outside of the wrongdoer's control, on future reflection.
To me, the basic idea "moral reactions are social emotions that benefited us in the ancestral environment" seems a satisfactory explanation for why our moral emotions, our felt-certainties about right and wrong, are what they are. And that way of viewing morality, something like Jonathan Haidt's Moral Foundaations theory, as opposed to the "everyone is given a conscience which is a moral compass built into us by a higher moral authority, and every sane and mentally intact person's conscience agrees on what is right and what is wrong" I was raised with, does a much better job of explaining the behaviour of the people I see around me.
With that said: On general principles, it seems bad to decide what the answer to a question is before you've applied your ability to reason, and then use your ability to reason to find post-hoc justifications that sound reasonable.
But _why_? Is it about outcomes? Sure, ”don’t do weird things to your body for no reason” could be a fine heuristic, but the whole point here is that there _is_ a reason. So that doesn’t seem to work.
But if it’s not about outcomes, what _is_ it. about? Aesthetics? Some unusual theory of value where your bodily integrity is _inherntly_ valuable but the life of a stranger isn’t? And how did you arrive at this highly unusual and ideosyncratic moral system?
Aesthetics maybe. So far as it being idiosyncratic I do note that Einstein declined life-saving surgery on the basis that it was 'distasteful'. I think he was 76 though so he may have felt he wasn't losing that much. But it does suggest that this style of objection is not necessarily super rare. Nonetheless, it seems mostly irrelevant ... we don't need to convince the 20% of people who have weird non-utilitarian objections, we just need to get 0.1% of people on board...
I suspect you are just exercising a value judgement. For example, you are probably against getting ears pierced, but have no problem with daily glucose checks for diabetics, which involve a finger prick. You can heal effectively immediately and with no distinguishable effects from a finger prick (not even a scar, very likely) so your "bodily integrity" is restored.
One has no need for ear lobes, but I can see feeling something missing, a lacuna to use Scott's (new to me) word, if one or both were removed.
If you feel this way, feel free to keep your organs. I don't see, however, how this should apply to others who don't currently have the visceral reaction you have. Why try to convince others of it?
If someone is born with a malformation of some sort, is a surgery that brings one closer to the median aesthetic appearance aligned with your rule? Because that person's "genotypic design", as far as I can make sense of the term, would be to have that malformation.
The very fact that you can identify something as a "malformation" indicates that you recognize a human norm from which it deviates. I'm talking about that human norm, which I do not put on an equal footing with the deviation.
But humans vary wildly. Leg extension surgery to extend height will bring you closer to the norm in The Netherlands, but further from the norm of pygmees.
So you do not care about the person's genotype, but instead about an idealized notion of an "ideal human form" which, in your view, all people should aspire to. Is that it?
I'm curious what the implication is of this remark - just pointing out something missing from what the post thinks through, or is the idea that this means that people should not donate kidneys?
I'm kinda surprised they prescribed Tylenol instead of Ibuprofen honestly. Anybody know why they did? I had anaesthesia for a cortisone shot to help with postpartum osteitis pubis, so no painkillers really needed, but I can't remember the last time a doctor prescribed me Tylenol when I wasn't pregnant.
Hey Jeremiah, thanks for your podcast episode on donating. I shared with my wife, and we're discussing for me.
How do you feel about recent research suggesting acetaminophen may be little or no better than placebo? This is a serious question for me - I suffer from frequent mild migraines, and being able to pop an advil or two ~weekly is pretty big for my quality of life.
A couple thoughts, keeping in mind I am not a doctor:
My understanding is that having a couple advil a week wouldn't really be that harmful. If you were doing 4-6 advil per day for weeks/months on end, I think that would be bad. But in moderation it's probably fine?
Other than that I'm unsure about the acetaminophen/placebo stuff. It seems to work ok for me, but it could just be that I'm very placebo-y. I also am lucky to have never had any real medical issues, so I had nothing to really consider like that.
What I tell people a lot is that we don't need *everyone* to donate. If 1 in 1000 people donated, the kidney shortage would end overnight. If you seriously consider it, and conclude that it's not for you, then that's ok.
Also, ibuprofen is a mild blood thinner, and as such is probably not ideal for someone recovering from surgery.
I was hospitalized a few years back for a possible brain bleed (head injury with an ambiguous CT read), and I was specifically not given ibuprofen because of the blood thinning effects. Between that and having an intolerance to Vicodin (unknown whether of not this extends to other front-line opioids), they apparently decided that my only two painkiller options were Tylenol or Fentanyl.
Fortunately, IV Tylenol is magical. Apparently, you can get a much higher dose to your brain by bypassing first-pass metabolism in the liver.
>Fortunately, IV Tylenol is magical. Apparently, you can get a much higher dose to your brain by bypassing first-pass metabolism in the liver.
Yes, I'd imagine so. For most drugs you can simply compensate by taking more orally than you would IV, but if the liver gets too much paracetamol it breaks it down wrongly and kills itself, so that's a non-option (hence the warnings on all paracetamol packages to not do this). Hadn't actually considered it before, but it makes perfect sense.
It also gave my the idea of buying the oral dissolving powder form of Tylenol and taking it sublingually in hopes of getting similar effects. It isn't as dramatic as IV tylenol, but it does seem to kick in faster and work at least a little better than swallowing pills.
It depends. Ibuprofen is routinely used for post-op pain where the surgical procedure is not associated with any specially elevated bleeding risk. Possible brain bleed is very much the opposite situation!
Reading about all these studies reminds me of this classic SSC post https://slatestarcodex.com/2017/08/29/my-irb-nightmare/ and the thought I had while reading it - why aren't there places that make medical research more frictionless in order to benefit (somehow) from everyone being incentivized to do their research there? You know, like the Delaware or Switzerland of medical research? Could some similar kind of clustering benefit organ donation as well as the attendant research? I'm sure there's a reason why this doesn't happen, but what is it?
Partly this is because most medical research is done with an eye to eventually pleasing regulators in a specific country, and those regulators want the studies to be done in their country by their rules. For example, to get a drug approved by the FDA, you need to show them studies done in America.
Some people advocate testing a drug in another country to see if it really works, and then, if it does, doing the study in the USA to please the FDA. The advantage there is that if it doesn't work, you can avoid the expensive US trial entirely.
But another reason is normal human and systematic limitations. If you are an ordinary medicine professor at (let's say) Harvard, and you want to know whether some heart thing you do in the hospital every day is beneficial or not, you probably don't have the money or capacity to get someone in China to study it on a Chinese population. You might just want to study the thing you're doing, in your own hospital, to see if it works, and then write the paper yourself.
Participant population becomes an issue if you try to cluster like this.
I think if you had a population of a city where every non-rich citizen was participating in 5 different medical trials at once, because the city set favorable terms that brought every medical trial in teh world to their doorstep, that population would no longer be a meaningfully useful control group.
Because someone who is on 4 experimental medications before entering your study is likely to have unusual readings at baseline and unusual reactions to your new medication.
Even if one thought UCSF's screening criteria were reasonable, they sound badly out of order. If a history of childhood mental illness is potentially disqualifying in their eyes, they need to ask about that history very early in the process and not proceed with CT scans (for most), nuclear kidney scans, or even time-consuming and expensive investigations until they decide if that history is a dealbreaker for them. Asking a candidate donor to incur risk, meaningful expense, and/or serious inconvenience before addressing disqualifiers like this just isn't respectful.
I've been thinking about this. Their current method is "do all tests, including psych tests and radiologic tests", then "convene committee to see if any tests are disqualifying". You could imagine a two-step process, where they convene the committee once for the psych tests, then a second time after all tests. I'm nervous demanding this because I imagine it makes things more expensive and longer for everyone to catch a tiny number of people in this situation.
Perhaps they could develop a system where anything potentially disqualifying gets flagged before they continue the testing. At the testing level that could be a checklist, which isn't good, but then they could convene the committee or a smaller sub-committee to evaluate.
It really doesn't make sense for them or especially the donor to go through a bunch of other tests if they can tell that the person is going to be disqualified earlier.
Roughly speaking, shouldn't they be doing the potentially disqualifying tests in order of increasing "cost" per unit probability of being disqualified? ( By "cost", I'm pretending that medical risk (e.g. the ionizing radiation in a CAT scan), time, financial cost etc. can be scaled somehow and combined into one number per test.)
That's a reasonable concern, although the number of people disqualified for _any_ non-radiological reason after incurring risk, meaningful expense, and/or serious inconvenience might be more than tiny. And it shouldn't take a committee to tell the candidate that issue X could be a dealbreaker and what the program's general attitude toward issue X has been historically. Given the facts you presented, I doubt the UCSF committee's serious concerns could not have been reasonably anticipated by staff. I think my irreducible minimum would be informed consent -- the candidate needs to know that there is a strong possibility of rejection based on the information on file before incurring additional risk, meaningful expense, and/or serious inconvenience.
This certainly seems like it's scheduled for the benefit of the committee members, at the cost of the would-be donor, and the medical practitioners associated with the tests.
I think a "Coordinator" or a "Patient Representative" probably has more pull with the executive committee of the hospital than a doctor.,
If something as small as 'distant history of childhood OCD' is a disqualifier, then I'd imagine that it is NOT a tiny number being caught, and they absolutely need to do the psych evaluation first. About 20% of Americans have a mental health *diagnosis* let alone symptoms of a mental illness in the past that might be disqualifying. I have few friends that would pass that screening.
I'm saying that if this is the case at UCSF, then they absolutely need to do the psych eval first before making people go through the rest of the medical testing.
I'm very happy for you, and completely unable to evaluate this rationally because a friend of mine died donating her kidney to her dying husband.
If you asked her in the afterlife, she'd probably be OK with the choice, but the incredible guilt that her husband felt afterwards is almost unimaginable.
Once again, I am being irrational and this should not dissuade anyone else; I merely was triggered to share my story.
I'm sorry to hear that. You're under no obligation to give details, but my model expected this to be pretty rare, so I'm interested in hearing any details you feel okay providing.
I never heard the exact nature of the complications, so I can simply relate that she was an extremely healthy ~50-year-old woman and she died on the table.
Yeah this is what I was thinking the whole time reading this article. Like, great, you have a bunch of studies and stuff (you know, the things that are constantly being dinged here for being full of fraud or just plain old incompetent) telling me that having my body cut open and removing an organ I'm using isn't a problem.
And I don't believe them. Sorry, but generally speaking if I have a thing, it's because it evolved to be there despite the costs of growing it (modulo the appendix?).
That's why people don't donate kidneys unless it's to their family. It's clearly risky. A bunch of discredited health people saying it's not risky isn't gonna change that - COVID showed clearly that they are the sort of people who will lie at the drop of a hat if they think it'll make people behave in ways that are somehow more "pro social" regardless of actual risk.
I agree with this. I've had supposedly 'low risk' surgery proposed for my own benefit and turned it down on the basis that I want an in-tact peritoneum without scar tissue, and that anesthesia itself is not entirely safe. I don't think the studies saying donating a kidney is fine make any sense, unless you consider maybe it's a selection effect - IE, anyone with any questionable medical issue at all is screened out first - so the comparison to the 'general' population is not a fair comparison. Really you would want long term randomized controlled studies comparing only perfect donation candidates who were assigned to undergo surgery or abstain. Anyway, it's a selfless thing you did, which is great, but I still think organ donation is an ethically tricky thing, and it's not clearly a slam dunk. I think it makes sense to really make sure the donors don't feel pressured in any way. It's not clear that having the option to donate makes all people better off.
> generally speaking if I have a thing, it's because it evolved to be there despite the costs of growing it
Epistemic status: I read this somewhere
One argument I find convincing is that kidneys and livers in particular were built for a more hostile environment than we currently live in (unless you're an alcoholic), and so have excess capacity. The acceptable age (at death) for donating a kidney or liver is higher than for lungs or heart, because they're under less strain.
TBC I'm not donating a kidney and don't expect anyone else to, especially for free. But I think this particular argument is weaker than it looks.
Isn't the appendix now thought to be a reservoir of your intestinal microbiome to facilitate rapid repopulation of your gut after an event (e.g., infection, poisoning) that causes the system to be flushed out?
Congratulations Scott! I became a non-directed donor 14 years ago. I was inspired by a New Yorker article by Larissa MacFarquhar, you may decide whether that's better or worse than Vox.
In addition to the very obvious benefits to the recipient, who is still doing well, I think donating helped me solidify my adult identity. Not in any public way, no one in my current city of residence even knows except my wife and whoever has read my medical file. My experience is that much as the rite of circumcision is meant to bind us Talmud-readers to God, kidney donation binds one to principles of altruism in a way no amount of donated money ever will. Even as I've gotten older and less idealistic, I remind myself that I am a man who once donated a kidney, that I should never let my character stray too far from that of the younger man who was capable of such things. No regrets.
While you might change your mind about what exactly constitutes moral goodness, it's good to have a reminder to strive for moral goodness as you understand it.
>a ritual called “therapy” could absolve one of this impurity
When I read this section, I had the following thoughts in rapid succession:
- As a psychiatrist yourself, you are qualified to perform therapy. And you do mention that OCD is one of the conditions you treat in your patients.
- So could you do therapy on yourself? It would certainly be simpler and more convenient than going to a non-self therapist. Probably not as effective if you actually had an active problem you needed help with, but it seems more than adequate for an exercise in warding off evil spirits.
- Autotherapy could defensibly be described as "talking to yourself", which put that way is usually considered a sign of not being sane.
- So for mental health professionals who are qualified to perform therapy, does talking to yourself make you more sane, less sane, or have no net effect?
There is a minor psychoanalytic tradition of "autoanalysis" or "self-analysis" but I don't think it gained that much support from most theorists, although it seems like it's not particularly impossible that it could be very helpful to some people. (After all, apparently you can make pretty consequential changes in your own mind in other ways, like meditation practices.)
I kind of doubt that the panel would have accepted anything like "I promise to perform therapy on myself to treat my OCD, if necessary" or "I promise that, as a psychiatrist, I would not currently diagnose myself with OCD". :-(
The effectiveness of autotherapy would heavily depend on the approach--anyone can do a workbook on their own, for example. Some people, professionals and lay, have a lot of discipline and insight and can do this kind of thing very well independently. But not all people, and not for all problems. In some approaches the relationship with the therapist is a functional part of the technique, which can't be replicated alone. Being a mental health professional likely aids a personal quest for better mental health but the physician cannot always heal thyself. In medicine self-practice is at best frowned upon and at worst disallowed, for reasons that also apply to autotherapy. It's difficult to be objective, it's easy to take advantages that hurt you in the long run.
Talking to yourself is not inherently pathological. While "taking to yourself" conures up an image of someone walking around in public muttering to the voices in their head (and that's obviously not a good sign when it does occur) most self-talk is just a way of augmenting thought, with no ill implications.
(Sorry, I know it's kind of a joke, I can't help myself sometimes.)
> Autotherapy could defensibly be described as "talking to yourself", which put that way is usually considered a sign of not being sane.
By who? Talking to yourself is something everyone does all the time. It's widely depicted in popular TV shows as being completely normal behavior. (And in this case, the TV shows are correct.)
I'm being facetious. The joke is that "talking to yourself" in the literal sense is a common and usually harmless and occasionally beneficial behavior, but the same phrase is also often used as a shorthand for specific behaviors symptomatic of schizophrenia: either disordered ramblings directed at nobody in particular or conversations held where the other party is the product of delusions.
On reading that Scott was turned down for kidney donation on account of having had mild OCD in the past, my first thought was amazement that something apparently so unrelated could be a factor in their decision. He may as well have been rejected for once having an ingrowing toenail!
Or that it cast doubt on his state of mind in volunteering to donate (i.e., he could have been feeling compelled to donate rather than choosing freely).
I guess the issue is that the radioactive dye in the scan is very specifically absorbed by the kidneys (whereas the CT is just kind of "throwing X-rays at all the tissue and seeing what bounces off"), and also that the nuclear kidney scan is essentially 2-D while the CT is 3-D?
the dose from the nuclear kidney scan can be on the order of 1/10 that of a CT scan, so it might not be appropriate to think of it as totally negligible, unless they're talking about a slightly different procedure.
The radiation cancer risk argument is just wrong. This is from modelling studies not from prospective or retrospective studies. After 127 years of X-ray use there is not one study in adults that has shown increased risk. The low no-threshold LNT theory makes no sense and even if it were true it should be proven in a longitudinal studies.
Radiologists and others who work with radiation despite protection would have increased risk of cancer because there is always some radiation absorbed. There has been no extra risk reported except in the early days when they did not understand risk of high doses.
X-rays are 1/300th the radiation level we're talking about here, so not comparable. I don't think anyone has been irradiated by CT scans enough to empirically discredit LNT, but I'm interested in seeing any studies you might have available.
I like Jack Devanney (a Thorcon molten salt reactor founder I believe) on LNT
In "Circling the LNT Wagons" he analyses a slightly positive LNT study noting that:
"They excluded the data they had already collected from 12 of the 15 countries because ``of the limited resources and consequent need for efficiency in project coordination." The three countries that survived this project coordination process were France, UK, and the USA. The three countries selected just happened to be the only three countries in the 15 that had nuclear weapons programs."
Nuclear weapons workers are more likely to have received acute doses. Based on Devanney's posts it seems really likely that LNT is either non-existent or non-provable below about 20 mSv acute doses
This is interesting in this case because you are talking about a 30 mSv acute dose. While LNT is likely to notably overestimate the risk at this level it is reasonable to think an elevated risk exists. Interestingly, one of Devanney's critics in his comments does not defend LNT but does argue that acute medical doses have a slight cancer causing effect. For most things it is again potentially unmeasurable but 30 mSv might be in the measurable range
In his "The LNT-is-not-inconsistent-with-the-data Argument" post Jack has a graphic of about 30 dose profile cohorts that are prominent in the literature and history. The only ones comparable to 30 mSv acute seem to be the nuclear bomb survivors:
14,000 with 5-20 mSv acute dose showed an insignificant decrease in solid cancers
6,000 with 20-40 mSv showed the same as control
11,000 with 40 - 125 mSv showed an insignificant increase
16,000 with 125+ mSv showed a significant increase
Leukemia numbers were similar except the insignificant decrease group was from 5-150 mSv
We've also done a lot of experiments in fruit flies to demonstrate that radiation effects on health are non-linear in them as well. But nobody knows where they start to go non-linear in humans and the dreaded bioethicists would surely prevent any good experiments determining that. So in the absence of good data we must make do with the simple rule we know is wrong for legal limits etc.
I've wished I could do this for years, but thanks to a life-saving, kidney-wrecking medication I'll be on in perpetuity both of my kidneys will be needed by me. I saw the headline "my left kidney," correctly guessed the topic, and immediately started sputtering about my own bad luck. Congratulations Scott, I am happy for you, your donor, and to see this issue publicized in a forum where I'm sure it'll get traction. Happy, and a little jealous.
Of course now I'm sitting here stewing on whether I'm a really a 200-in-a-few-hundred-millioner who would really go through with it or just a 25%-er with a fond intent and a pat excuse. It does feel like the easy, obviously correct choice--a life you can save that will be practically right in front of you--but now I'm very suspicious of this little fantasy and the role it plays in my psyche, with no skin (er, organ) in the game...
(If anyone else is worried they just have a hero complex and their heart isn't entirely in the right place, don't let that deter you from putting your kidney in another one. We all appraise ourselves in creative ways.)
Unless tests reveal some unusual asymmetry, they take whichever one has longer blood vessels that are easier to manipulate surgically, which is almost always the left.
How does it feel knowing that your evil kidney is likely now directing some poor stranger to turn to the dark side? The writer that you are, that kidney may be too persuasive for them to resist...
My immediate reaction to the apparent mystery of : "25-50% of Americans say they *would* donate a kidney to somebody in need..."
I think those 25-50% are thinking of a scenario somewhere in between
-rushing to pull people out of a sudden immediate fiery car crash right in front of them
- donating or volunteering in a natural disaster
- John Cleese showing up at their door asking, "Could we have your kidney, then? Won't be much trouble for you."
When the choice or opportunity is suddenly presented, and following through is relatively simple, logistically, people and Americans in particular have almost no limits or thought of risk/cost. In the scenario of a crash/wreck I am sure 95% of people would risk their life for a total stranger without a moment's thought.
The barrier to high leverage humanitarian intervention is not courage or selfishness but attention span. Even you, a person who thinks and cares about doing good, who inspires others to likewise try to improve the world, and an MD with major cheat codes for Health Care and Medical melee combat, you were discouraged and almost gave up. Until a Mysterious Mentor suggested a Surprise Approach, One Weird Trick of trying another donation pathway, tvtropes etc.
Leaders can be described as getting people to do good stuff they should do anyway. Personally, I always tell people that when thry ask somebody for a favor, make it *AS EASY AS POSSIBLE* for that person to help you. The path to better more effective Altruism, and government as well, should keep those things in mind.
Sounds like we need to recruit a corps of door-to-door proselytizers, then, and maybe lock a bunch of bioethicists and con artists in a room together, unable to escape except by agreeing on details of a training program for professional kidney-donation-facilitators which somehow threads the needle of making the process easy enough to actually complete for people who should be donating, without misinforming or coercing people who shouldn't.
As it stands, nobody goes through the process from the donor side enough times to become an expert on it, and the skill-set of making things easier for a customer is valuable enough to be in demand elsewhere.
Could just lock all the bioethicists in a room, throw away the key, and try to reassure people that they around to hurt you anymore, you can do medicine now!
And sadists! Suffering is a sign of virtue, so therefore by making people suffer one can increase the amount of virtue in the world. Just look at all those stories of people who went through adversity and came out better. Who wouldn't want to have moral justification? Any reluctance on their part is simply akrasia. (Or at least, that's what my PTSD says.)
> Would, if what?
Quite possibly, if my life were more together. But thanks for writing all this.
I've been torn about the prospect of donating a kidney for over fifteen years. On the one hand, I see it as a really worthy form of altruism, and I recognize that in absolute terms the risks are quite small. On the other hand, I'm quite vulnerable to anxious intrusive thoughts, and the anxiety of having only one kidney, when evolution saw fit to equip me with a spare, feels like the sort of thing which would genuinely weigh on my sense of well-being for the rest of my life.
Do you think you might be open to a literature dive on the pros and cons of donating regenerable organs and tissues, like liver or bone marrow?
Anxious intrusive thoughts about only having one organ were a concern for me too. I tried telling myself I would do some healthy things (stop adding salt to food, go to the doctor more often) that would probably make up for it, and that sort of helped. So far I haven't felt too anxious-intrusive-thought about it, but partly that's because I'm still in the more acute kidney failure stage of recovery where I'm expected to feel bad, and I don't really know what the future will bring there. Ask me in a year.
Scott has written before about not really being a fan of food in the sense that a lot of people are, and I suspect there's a general trend of this kind of underrating general experiences (even coming from the guy that wrote "what universal experiences are you missing.")
I know there's a renal diet for people with kidney disease/on dialysis (mainly be very careful with potassium and if you eat potatoes, you have to twice-boil them which reduces them to a mush that is difficult to eat so you may as well cut them out altogether).
Seems there is a diet for kidney donors; moderate protein, reduce salt intake, be careful with supplements:
I looked into liver donation after getting denied for kidney donation and the risk is way, way the fuck higher. Something like 1% fatality risk in the immediate aftermath. I was comfortable accepting "twelve hour drive" risks to save somebody's, or multiple somebody's, lives, but not "die at any point in the next year or two" risks. If you do survive without issues, your liver returns to full function.
There is literature suggesting that missing-spare-kidney intrusive thoughts are a real risk, which is why they reject people with OCD. So 1) maybe kidney donation isn't right for you, and 2) if you decide to do it, you probably don't want to disclose your concern to your donation team. Like Scott, I was rejected for mild OCD, and I really wish I hadn't been so honest in the psych eval.
I personally think it's not for me, because it's not just that I'm generically prone to anxious intrusive thoughts, there are specific things that cause me anxiety which aren't necessarily intuitive to other people, but I find predictable in advance. For instance, I have no problem engaging in martial arts sparring, but I refuse to ski- I can't help envisioning myself rolling down a ski slope with a ski pole stuck into my eye. I can forcibly fight down anxieties which I know are irrational, but it doesn't make me comfortable, and I don't want to spend the rest of my life doing it.
Conversely, some things that other people worry about don't bother me at all. I'm not paranoid about the dangers of a routine surgery, for instance, or low-level radiation exposure. I'd be happy to be able to bring my kidney-anxiety down to a level where it's proportionate to my other worries, but I don't think I'm actually able to do that.
Yeah, sounds like it - and I hope you don't concern yourself over the question "should I donate or not." You have a contraindication and it isn't reasonable to sacrifice your own well-being.
I get how anxieties can be different, but predictable to those who have lived them. My anxieties are around ethics, i.e. am I doing right by others; if others aren't doing right by me why doesn't anyone else notice and does it mean there is really something wrong with me. And I can be OCD about the uptime and quality of software systems I build. Besides that, I don't have much in the way of intrusive thoughts - which is why I was pretty confident I wouldn't experience the without-spare-kidney anxiety.
Yeah, the anxiety caused by the risk of dying later on due to donating would make me significantly worse off. Imagine how crappy you'd feel if you died because of that! You'd feel so stupid and like such a sucker! "If only I hadn't donated," you'd think. Anything would be better than having that kind of regret and fear your whole life!
As an aside, I'm surprised that you read Scott's piece and concluded "the risks are quite small" - I found this article scary.
I did some sort of thing where I gave my dna via cotton swab to some charity and said email or call me if anyone needs something I’ve got. It seemed legit, but no one has ever contacted me. And I assume my superior Slavic-Irish-Norwegian ancestry would greatly enhance a normal mortal life.
Asking because I suppose this group would know: Is that in fact a real thing? Or did I give my DNA to skynet? I swear I got it from a flier at a hospital.
Maybe they don't actually share DNA information about different kinds of prospective tissue donations? (which I guess would be kind of wasteful, if not)
As Seth said, bone marrow data bases work like this. For a bone marrow transplantation, you have to screen millions of people to find a match. So they build huge databases (for example 7 millions just in Germany, ~10% of the population), and only contact you if you are a match for someone in need. The chance of ever being contacted is less than 1%, but the system only works because of the huge DNA databases.
I did this for my local bone marrow bank. They contacted me a decade later and told me there is a potential match, but never reached out again, I presume they found a better match.
Scott, have you thought about meeting the person who got your kidney? Of course it might be awkward, meeting a stranger whose life you saved, and you two may be so different that you're each incapable of comprehending the other's take on life. And yet you had a meeting of the minds and kidneys when it comes to saving the person's life. I'd want to shake their hand or hug them and say, "I hope that kidney makes possible all kinds of wonderful things in your life" -- or something like that. Maybe just "enjoy the hell out of that kidney."
There's something about direct giving to strangers that feels utterly different from EA. It's profoundly satisfying, and makes you want to give *more.*. Maybe the way to think of it is as a spiritual practice, one that people practicing EA need to do to stay in touch with the point of helping others?
Anyhow, bless you, Scott. And if it would make you feel any better about the Uber incident, I'd be willing to piss myself in an Uber for you.
But why be sure they'd loathe each other even under ordinary circumstances? Scott himself could be called a real stickler by some, and they'd have a point. In the most recent open thread I showed some people Scott's kind-true-necessary, 2 out of 3, guidelines, and the people had a low opinion of them -- saw them as suppressing free speech, suppressing justifiable expressions of rage at various actors in the Palestinian-Isaeli situation, so vague that any judgment could be defended, etc etc. And is what people eat really such a big deal? Anyhow, even if Scott and Stickler would have loathed each other in other circumstances, having a moment of intense shared emotion is all the more special then. And I'm guessing that even most meat-eating sticklers aren't so hard-boiled that they are not moved by someone having saved their life.
Almost certain both of those people were joking, implying Scott's Kidney went to someone he wouldn't like and who makes the world worse, in a sort of "accidentally saving baby Hitler" scenario.
There's probably no way *you* could look up Scott's Kidney recipient, for medical privacy reasons (Scott might be able to, not sure).
i think in some cases you are allowed some contact with the kidney recipient via email, but it has to be completely anonymous and is reviewed by censors before being forwarded on.
Yes, that might be. Seems pretty micromanagerial to me, sort of like the bureaucracy that would not let Scott be a donor because he's had mild OCD as an adolescent. I have seen articles about people who donated a relative's heart meeting the person who received the heart. Donors meeting recipients seems like on the whole likely to be a very positive experience if both parties would like to do it.
Seems very disturbing. What if you didn't like the person? Here you made a significant sacrifice, giving up your health, and it was for this person?
And what about the power, obligation, control, and guilt issues? They meet you, and they feel like they owe you something, or you feel like you owe them something ... really disturbing. Seems like it would be hard to relate to them as normal humans with such a huge debt there.
You'd always resent them for having one of YOUR organs that belongs in YOUR body! You'd get angry every time they did something you didn't like, or disagreed with you, since they basically owe you everything! Just an unhealthy relationship.
I'm sure many donors and recipients would not want to meet. But there are all kinds of ways a meeting like that can play out. The ones you imagine are only a subset of the possibles. Some people's take on the process may be one that protects them pretty well from going down these grim paths. If had donated a kidney I think I would want to meet the recipient. I'd have assumed when I donated that the organ would be going to someone who does not share my attitudes, beliefs, politics, taste, etc. After all, most people don't. I think my feeling of connection with the unknown person who was going to get my kidney would have been that, like me, they want to stay alive, keep seeing the people they care about, keep doing the things they enjoy. Part of the specialness of charitable giving is that you are letting go of all your angry stuff about the many many groups of people who believe and do things you think are pointless or evil -- at least letting go of it to the extent that you believe they do not deserve to suffer. So if when I met the recipient they were wearing a campaign button for some candidate I didn't like, that wouldn't matter. And I don't picture having a big get-to-know you meeting with them -- just talking over the thing we have in common -- the experience, how we're each doing, and wishing each other well.
As for their gratitude -- of course they have to say thank you. Etiquette sort of demands it. But I would try to get across to them that "thank you" doesn't exactly apply in this situation. If I had chosen them as my recipient thank yous would be in order, but I didn't. I gave the kidney to humanity at large. It was luck that sent the kidney to them in particular. So I would tell them that, and tell them that giving it had given me a lot of pleasure, in fact made me sort of high, so in my own way I had benefitted greatly from the experience. Maybe add something about how I I gave the kidney to humanity at large -- if they feel they owe a debt, they can work it off by giving something to humanity.
So there's a 1 in 10,000 chance of dying during the actual surgery, but there's a 1-2% chance that you'll develop kidney disease later on in your remaining kidney and think "boy, I sure wish I still had that extra kidney right now". BUT, you'll be put at the top of the list for the next kidney. BUT, kidney recipients typically only live an extra 5-7 years anyway. BUT, under these kidney disease circumstances you might not have been okay with a second kidney anyway. Nonetheless, your chances of dying due to kidney donation seem to be higher than 1/10,000 due to the whole lack of redundancy thing, probably very much greater than the 1/660 risk you were concerned about.
"Dying" isn't a very good binary variable. I think there's a 2% chance you'll die six months earlier than you would have otherwise, but multiply that out and it loses you 1.2 days of life. Dying during the surgery seemed important to me because it loses you a lot of life as opposed to shaving off the very end when you have no GFR left anyway.
Doing this properly would involve how many DALYS you expect to lose. I think I looked at someone's calculation and it was in the range of a few weeks, probably so much that the variation in length of your recovery period is bigger than the amount contributed by early death or early disability considerations. I think the Tom Ash post I linked might have those numbers on it, although I might be misremembering.
Okay but this is all "present rate no singularity", yeah? If you have a reasonably high probability of a good singularity, then dying a couple of years early in the coming decade might lose you many, many more highly enjoyable years than a naive approximation would suggest.
(IIRC from your old cryonics post you don't care *that* much about your mortality as distinct from suffering? Which, fair enough. But I would assume that most people worried about life expectancy post-surgery are not like this, so it feels worth mentioning.)
The bit about how you can get five other people get bumped to the top of the list if they ever need it is a REALLY convincing point. I didn't know that: I heard about how you personally get bumped up the list, but that's the bare minimum, not a good deal.
Worth noting that this is not very gamable, and they make it really clear that the set of you share a priority-claim on up to 1 kidney. From the look of things, once someone uses it, the others do not have the priority mark anymore.
Thanks for pointing this out. Then it's a non-obvious tradeoff between a larger list of people you care about to whose kidneys yours are compatible, and a smaller list (five people) which could include incompatible people. That's … decidedly less convincing now.
Not sure if this untangles the non-convincingness, but from what I understand, you can "donate a kidney to a loved one" even if you're non-compatible. What happens is that you donate your kidney to a compatible stranger and in return they ensure a compatible stranger in a symmetrical situation donates their kidney to your loved one. I think this is commonly the way it works.
Re the people who say they would donate a kidney to help a stranger:
I think most people answering the survey question are imagining a case where they're uniquely morally responsible for it in some way, in which case they'd do it.
Going by your numbers, the actual number of undirected kidney donations required to plug the gap is about 0.01% of people per year. So IRL people are probably morally responsible for about 0.01% of a kidney donation per year (probably more in practice because some people can't or wouldn't donate, let's say 0.04% for safety), and going beyond that is superegatory.
I'm on the list of people who'd answer "no" on the kidney donation question (I do feel bad about it). But I would sign up for the service that picks 0.04% of people who sign up at random each year to donate, if it solved the kidney shortage. I wonder how universal this is.
(This does raise the question of why I don't just make my own service by throwing a random number generator from 1 to 10,000 and donating if I get under 4. I did do this before posting and got 5,143, so that's my new excuse for not donating. But I don't know if j would have gone through with it if I actually had gotten a number under 4, so I don't feel great about it).
Your comment got me thinking - I would probably also sign up for such a list, if it existed and - I think this is important - if a lot of other people also signed up, so that my odds of donating were "fair".
But then it occured to me that something similar already happened in the UK. A few years ago we switched from opt-in organ donation to opt-out. Essentially that means that if you die, you are now assumed to consent to organ donation unless you explicitly said you don't consent.
In a way that is similar to drawing lots, since we can assume I have some chance of dying randomly in the next year and some chance that my organs are suitable for donation. I am not sure that enough people die in the right way to fill the gap, but I suppose it should do something (especially as each suitable person would be able to donate both their now unused kidneys, plus other organs like hearts, lungs and livers).
Unfortunately I can't find much saying it has really had an effect. Partly that seems to be because it was introduced just before covid, which has muddied the numbers. In essence, though, the number of people on organ waiting lists seems to be pretty much unchanged or even slightly higher.
The difference between opt-in and opt-out is notable, but does not change the order of magnitude, unfortunately. Looking at different countries who changed one way or the other, the number of donations may increase by 30-40%. (Less if relatives still have veto rights, which they do in some countries.)
In practice, most donors are young people who die in accidents, like bikers. Most of them haven't declared their will, so usually relatives are asked to find out their will. In most countries it boils down more or less to the same decision for the relatives, regardless whether it's opt-in or opt-out.
30% more makes a difference! The supply is not THAT much smaller than demand. But it is still not enough to get enough organs. The number of people whose organs can be used (who die young from accidents) is just small, and the number of people who would need organs is pretty high.
A thorough literature review with in-depth discussion for Italy, France, Wales, Greece, Chile and Singapur is here (in German, so you need an auto-translator)
I am also on the list of people who'd answer "no". But on the other hand, I did register for bone marrow transplantation. There they screen huge databases for the best match, and you are only contacted if you are a best mathc. Which happens for less than 1% of registered potential donors.
This system works very well. If you are contacted and told that they particularly need your bone marrow because there is this one person who needs it, then I do believe that many people would say yes. Perhaps the 25-50% who answer yes in the surveys.
In principle, this could also work for kidneys. Build a huge data base, for each patient try to find the best donor, and ask them whether they would help this particular patient, because their help would work better than anyone else's.
It's almost a shame that kidneys are compatible between so many different people. Because that might be the main reason why the solution doesn't work. (Even if chosen, you are not really a much better pick than many other people.) So the ethical pressure is diluted. We might have much less trouble to find kidney donors if they weren't so widely compatible.
Or the solution does work, and we just need to try it.
Agreed. "There they screen huge databases for the best match, and you are only contacted if you are a best mathc." Also, there is (or was? this was over a decade ago) a secondary screening where they take another sample and check more antigens. I was contacted as a potential marrow donor at least twice (I forget if there was a third time), and I think I was the most probable donor at least one of those times, but they never actually took my marrow. I don't know exactly what happened to prevent it. ( I've aged out of the registry at this point. )
Interesting. I have no idea what was going on for you.
Funnily, I was chosen by them, too... as statistical twin to a real donor. That's why I never forgot about it, I get a form once a year to tell them if I am still healthy.
I have the vague recollection that something had changed on the recipient's end, but I wasn't told whether it was positive or negative (which is perfectly reasonable for their privacy). I too got a contact once a year (till I aged out of the registry) asking if I was still willing and able to donate.
Overall, it was a very positive experience and I would recommend that folks sign up for the registry if they can (for the US, it's "Be The Match"; for the UK it's "Anthony Nolan")
Hey Silas, thank you very much for taking the courage of writing your experience down! I was always a bit nervous about whether I would really say Yes if I was ever matched. But after reading your post, I am now a lot more confident that I would go through the whole process. As you say, reading about personal experience adds a lot to all the statistics which say you'll be fine. Thank you for sharing!
You might've stumbled on a back door way to financially compensate kidney donation (in expectation): it's probably not illegal to pay people to sign up for such a service as long as they have the ability to back out if selected. Conditioning the payment on passing screening could do multiple duty of (a) weeding out low-intent volunteers, (b) keeping the average quality-as-a-donor on the list high, and (c) enabling payments amounts large enough to actually incentivize sign ups.
I don't think there is an official age, and it probably depends on your health, but I think being older than 50 probably changes the risk calculus to a point where I would be reluctant to do it, though this is just a gut feeling and I haven't looked into it too hard.
Was there really a need to tell the whole world about the good deed you have done? Performing good deeds for social affirmation is generally considered to detract from the goodness of the deeds. Yes, I do understand that your intent is to encourage more performance of such deeds. But conventionally, performing good deeds for external rewards like social approval or money is considered suspicious, for some poor reasons (like the masochism you mention) but also the tendency toward self-deception and institutional corruption by those rewards.
This directly ties into the castle thing. Perhaps it's true that the castle actually would encourage more good deeds be done. However, it's also true that if you start talking yourself into buying comfy castles that actually do good, it becomes easier to talk or trick yourself into comfy things that don't do good, and you start to attract people into your organisation who will talk you into buying comfy things because they are solely into comfy and not good deeds at all. We can try to be less wrong here, but can we be sufficiently less wrong that this risk is worth running?
1. If you tell other people about your good deeds, you feel good and get benefit from them, which is an incentive. People do things that are incentivized more often than they do things that aren't incentivized.
The castle thing seems like the opposite of people being corrupted by social approval; they did a genuinely good thing even though they knew everyone would hate them for it. I have immense respect for that. I agree that if (unlike them, but like me) you do something that you could get social approval for, you have to resist becoming a social approval slut rather than being focused on what's really good, but I think it trades off against other considerations. And I think that if you think about that *too* much, then at some level you start becoming an actual masochist who is optimizing for your own suffering rather than make anyone better (Should I help this orphan? No, I would enjoy seeing the smile on his face. Better whack myself in the head with a cactus instead!) and that the point where I worried about posting this for those considerations would cross that line.
I'm finally reading Elephant in the Brain, which unsurprisingly is very fascinating, but the most fascinating thing so far is that 95% of (monetary) donations people make is due to solicitation (as opposed to unprompted decision). For organ donations the percentage would likely be even higher, and a respected public figure leading by example is up there in terms of effective mass solicitation.
This is an impressively calm and polite response to an infuriating comment. If I were in your position I would probably be banning myself from my own blog right now.
Congratulations on making such a big (& effective) altruistic sacrifice. Any warm fuzzies & reputational benefits you get from this are very well deserved!
I'm fairly sure that in a couple of years time they're going to end up selling the castle because they'll find that they're not using it as much as they expected, and the upkeep costs are way more than they imagined.
This doesn't mean they are not good people, nor am I saying they are not. Just that the castle decision is not a good one.
If they end up using it below capacity for their own purposes, they don't necessarily need to sell outright to recoup the cost. Could simply rent it out to others similarly dissatisfied with pre-existing conference-center venues, then spend net revenue from that on EA. That would effectively mean they were now working at least partly in the real-estate-management business, but if that's where the big money is, and the money still ultimately gets spent on saving lives as efficiently as possible, why shouldn't they?
I would be interested to see a good argument in favor of buying the Abbey being a good idea.
To my understanding, the case for is:
>CEA (Now EVF) hosted conferences, and aspired to host more and more regularly, and owning a permanent conference center would be more economical than renting every time.
>The Abbey was a large, seemingly suitable property in a good location, and on the market.
>Open Phil wanted to invest in the movement by spending money.
The case against:
>Horrible optics.
>Other properties were apparently available for cheaper.
>It is a Grade 1 listed building, as such any modifications become significantly harder should they become necessary, compared to other properties which could have been cheaper.
>Is it really worth buying a $15m Abbey, or even any sizable real estate, instead of just more malaria nets or something?
Arguments made in favor that I don't think are actually in the case for:
> The Abbey purchase was made with a specific grant with funds earmarked for it by the donor. However the donor was Open Phil who presumably could have been nudged towards another purchase, not some eccentric who would only give money to EA for specifically the purchase of the Abbey.
> The Abbey will retain value and can be sold later. I don't think it has been, despite the dramatic changes to the EA funding space after FTX, so I am a bit skeptical this was ever a pro.
My impression is that Lighthaven has gone very well, and the people involved (including me) still endorse their donations and work on it, even though money is tighter now.
(also, awkward to talk about now, but FTX promised every EA organization approximately infinite money in 2021, and if you're the conference-arranging organization and have just been promised infinite money, something like this seems like a pretty obvious next step).
I looked through the thread, and the purchase of the Rose Garden Inn seems like a much better idea than the purchase of the castle.
The Wytham Abbey is a Grade 1 Listed property with all sorts of difficulties in renovation and maintenance. It's gone through a mix of being a private residence and used to host 14 apartments for Oxford. It has terrible optics for being purchased by a charity. The justification appeared to be that it would be used for far more events in the future than had been hosted by CEA in the past, including having residents stay there rather than stay at hotels and commute to a conference center, and would therefor come out ahead, but I am not sure how to find any information on how it has actually been used.
The Rose Garden Inn was a hotel. A nice looking hotel to be sure, but it does seem much more suitable for being the workhorse of an organization that will regularly be hosting large groups of different people. It has much better optics, I don't think anybody has complained about ' charity org buys hotel/conference venue for people to stay at for conferences', or would to the same magnitude as 'charity org buys castle to turn into conference center'. It seems like it's up and running, and is offered for cheaper compared to traditional conference center per day per person costs that I saw thrown around in the Abbey threads. I think it was a good move. It is an actual event venue good for running events that is already being used for running events and may actually be profitable to own.
I wouldn't mind CEA buying a normal hotel/conference venue, quickly turning it around, making it available for use for likeminded groups at a cheap/subsidized? price. I think that's what the goal was with Rose Garden Inn and it worked out really well. Instead, CEA bought Wytham Abbey, which has terrible optics, seemingly less capacity, more building restrictions, less liquidity as such a specialized property, and while I haven't been exhaustive the original post about it was edited on 9/1/2023 and didn't add any information about it currently being in use.
Reading more about the Rose Garden Inn has only more convinced me that the Abbey purchase was a mistake, it seems like after 'Step 1: It would be a good idea to own a permanent conference center' they diverged drastically.
To be clear I don't know much about either transaction but I do have much stronger priors against charities buying castles
Are you worried about people lying about donating kidneys to appear virtuous? Or being peer-pressured into donating kidneys when they don't really want to? Neither of these seem likely.
If you're virtuous, people *ought* to know it. Transparency existed in (paleolithic/metaphoric) Eden. We abhor it today because we don't trust others to follow suit and therefore fear society judging us uniquely anti-virtuous, thereupon becoming subject to the tender ministrations for which the mob is so rightly famous. The consolation of such correctives being administered in the news and courthouses rather than on your doorstep fails to assuage the perturbations of most minds.
But a standard of openness? Why that would be lovely. And it might just help us choose the right people for leadership too.
On a personal note, I consider it a moral virtue to share about myself that I donated two kidneys and also that despite lacking the normal executive skills of even your average 10 year old, I managed against seemingly insurmountable odds to save the life of an old man who was being tortured to death in Chechnya.
EDIT: I did not actually donate any kidneys. The most I did in this regard was speak about Zell Krivinsky for 3 days straight on my radio show after after he donated his own kidney.
But yeah, in an improved society we would definitely be taking into account the red's "needs and abilities" thing, and thus through public discussion come up with a means for resolving (among other things) the distribution of kidneys.
Ideally we'd manage it with a lot less force and at least a touch less gulag.
Instead we might, I don't know, accord honor and love to those who enjoy utilizing their abilities to solve the needs of their brothers?
While my claim of having donated ≥ 2 kidneys is apocryphal, my claim to have rescued an elderly, terifed, abused and doomed stranger is 100% true.
Months earlier I had achieved something like total self abnegation wheresoever my own comfort or pleasure could be keeping me from doing al I could for the life and happiness of my fellow human beings.
I'm sure it sounds mad or bad but it wasn't. It felt good and was good. It was eventually necessary to transcend and to reacquire a biased interest in the individual human unit in whose body I happen to live, but I do not regret having achieved what I imagine very few people have ever achieved. I mention it because it's the only way that something so far beyond my own ken could have even come to my attention, never mind be resolved by me.
When it came to my attention I immediately swore off food, mattress, small talk, etc. and set about informing the various relevant powers and authorities, which turned into negotiating betwixt them which turned into the realization that he was going to be murdered on Adolf Hitler's birthday unless I find a way to free him myself. And, God (or whatever name you might call astonishing Reality) helped me save his life.
All his teeth had been drilled out and he was missing fingers. He had been starved and made to suffer incomprehensible tortures but because of me and only because of me, an old Jewish man was not murdered on Hitler's birthday but was instead rescued on the first day of Passover.
And, much as I was trained to believe and act otherwise by sklavenmoral's third rail, I now believe that it is good for people to know this about me and I am acting upon that belief right now.
I can't tell if this is a joke, fiction, satire, or what, but what on earth are you talking about? Who did you rescue, what was the total self abnegation, and what is sklavenmoral's third rail?
But if even if you tell no one, you'll still know yourself, and it will affect your future behavior. This is the missing factor that causes the "ice bath" solution to rise to a score of 3, tying with the Weill center. By having charitable deeds thrust upon them, the donor can remain uncorrupted by virtue.
And even nobler would be to force yourself, against your own will, to shudderingly harvest other people's kidneys and donate them to save people whom you'd rather be trolling.
Or even better, blackmail or take hostages to get someone else to do the unwilling harvesting! We can keep adding extra layers of rabbinic fences to protect us from the horror of altruism.
Come to think of it, this is probably how a D&D Lawful Evil society arranges to do things that are socially useful but which also count as "Good".
Isn't that the same kind of ethical dilemma as the trolley problem - the surgeon who can kill one patient to save five others, or however it goes?
If it's the superior choice to pull the switch on the trolley, then becoming a surgeon so you can harvest organs from non-consenting (because you never asked them, because if you asked they might refuse) donors is also the superior choice!
Hey David Khoop, does the same go for mean-spirited gotchas? I mean, isn't it more dignified and pure to hit the recipient with them in private? If you do them on a forum like this, there's a danger you'll slide into looking for an angle to gotcha from just for the pleasure of being seen biting somebody's butt in public.
Was there really a need to tell the whole world you are a human faceache?
People were wondering even last night as to where Scott was or what he was doing. Now he's told us. And he's told us about how to go about donating a kidney if we want to do so.
This is not the charity of the Pharisees, this is informing us about the need for organ donations and the way to go about it, and the likely obstacles in your way. This is not "look at me, how virtuous I am" - which, by the way, is how *you* come across; "I would *never* tell anyone about my good deeds, amn't I so special?"
Like the apostles complaining about the ointment that could have been sold and the money given to the poor, yeah, you're so specially good.
Buying a castle is self-serving. Donating a kidney is not.
My wife is in kidney failure and is on dialysis. We have the same blood type, and when she becomes eligible for a transplant (she currently has other conditions that make her ineligible in the United States), I intend to offer one of mine, assuming I'm qualified to donate.
I'm happy for you! My apologies for complaining about the lack of posts just yesterday.
As a PhD student, I used to grow kidney organoids - small clumps of kidney tissue derived from embryonic kidney progenitor cells (or Yamanaka-factors induced stem cells). They were amorphous in shape and couldn't grow past a very small size limit: there were no blood vessels inside, and the center of the organoid would begin to necrotize from lack of oxygen. Growing a full-sized kidney in a lab would require a much better understanding of vascularization during embryogenesis.
A cool workaround I once saw in a Finnish lab was to literally 3D-print a microchannel tree, and populate it with thousands of mini-organoids. I haven't been following the field since, so if anyone is aware how close we are to a 3D-printed kidney, let me know.
Also, whenever I told my casual dates what I'm working on, they used to ask "Are you going to steal my kidney?". I would have to explain that I'm literally the least likely person to steal kidneys, since I can just grow them in the lab.
How important of a limiting factor do you think is the risk of it collapsing under its own weight while half-grown?
I've got a weird, tenuous-but-hopeful theory that artificial organs being dependent on microgravity for some key assembly stage might be the key factor that makes early stages of a city-sized station in low earth orbit economically viable. i mean, what else is there that's both high value per kilogram, and has high-volume demand which can't be met more cheaply by building things closer to sea level?
I don't really see the potential advantage to making those in space, or how they'd lead to creation of thoroughly human-safe environments which could then build secondary services. Also, saturating low orbit with communication satellites will reduce demand for ground-based fiber - speed of light through air is faster, so a "bent pipe" relay can actually have shorter ping times across continental distances despite the longer path.
Not sure about scale though. I'm imagining quite a small facility, as part of a mostly whimsical idea for a system where the cables are created as giant lengths trailing out the back of the space station before being parachuted perfectly into position on the Earth's surface!
Ah, of course, diffusion without convection for uniform alloy mixes. Still, that sounds like microgravity is only making certain industrial processes easier and cheaper, rather than "possible at all," and in relatively niche applications.
If artificial organs and tissues overshoot demand for life-saving transplants, retooling into luxury food might be relatively trivial, and there could plausibly be upwards of a billion people who'd eagerly make room in their weekly grocery budget for a few kg of vegan beefsteak.
My only connection to this issue is that I have a friend who attempted to donate a kidney to a stranger through UCSF, and I think ultimately also got rejected or else long-term deferred, for a reason that seemed to also be like "we reject everyone who has an issue that falls into this bucket" rather than "it's plausible that you would actually be endangered if you donated your kidney".
This makes me wonder if UCSF is like super-paranoid about approving kidney donors.
Another thing that could fall under point #7: I think the kidney donation charities or maybe insurance companies are also willing to pay some expenses of a friend or family member to support you in connection with the kidney donation. So you might be able to, for example, take a significant other with you at no charge to you, even if you had to travel for the surgery.
Not sure. If a certain ex-boss of mine got the kidney: Nope. - But you got me thinking: What is the second best use of Scott's body tissue to better the world? (The best is his use of his brain to write.) Obviously: sperm. Most likely the UCSF would turn him down - If I were female, I would not. Now I wonder: Why I do not see offers like this more often in the comment section (I saw one on ssc)?
Ah, I see, this is a "trick desperate or low-intelligence people into serving the greater good" sort of deal. That's the only way to describe someone who would actually act upon a promise by the government not to screw them over using the tax code for the next 11 years.
Huh, I distrust the government in a lot of ways but this seems like the opposite of the usual failure mode. Would you like to make a bet on whether the first person to get promised this gets their full payout? Feel free to name the amount and any other terms you find relevant.
My model of DavidC would be reluctant to take the bet. The *first* person to get promised this might get a lot of media attention incentivising the government to do everything smoothly, even if ten years down the line, when the program has faded into normalcy, we expect things to regress to a mean where the government casually screws later donors over.
I understand it's illegal to pay someone for their kidney, but maybe it's not illegal to offer someone an insurance policy against changes to the tax code? Then maybe there's a solution for folks who trust some private insurance company more than the government. (And if the pro-donation organizations are allowed to compensate you for airfare and lost wages, maybe they can also pay your tax-change-insurance premium too?)
Like if the government did some funny business that meant the amount of taxes you needed to pay went up by $10k per year, you would still get the full payout of $10k tax credit per year, but you’d still be paying the same amount of tax overall
Also if you get $10k of tax credit you’d be encouraged to do stuff that might increase the taxes you owe by $10k per year so it’d be hard to separate self-inflicted funny business from state-inflicted funny business for the sake of a bet
Just the people receiving the tax credit, I expect it’s normal behaviour for people receiving tax credits to spend more & thus be taxed more
I don’t have confidence that tax credit recipients would be targets for sneaky tax increases from the government(probably the opposite since those receiving tax credits presumably have lobbying power to negotiate tax credits and that lobbying power is probably good at preventing tax increases too)
At least in the US, you're taxed on income, not on what you spend, so spending more would not lead to being taxed more. If you spent it on tax-deductible things, you'd get taxed less.
I missed this because of substack weirdness. My first thought is that I think it unlikely such a scheme would ever go into effect in the first place, with a higher degree of confidence than my claim about what would happen if it did. That's poor grounds for a bet.
But what Edmund said is probably my better second answer. It'll go until it doesn't; I expect the same thing from SS just like everyone else in my generation[0].
[0] Generalization not guaranteed; use caution when handling this hot take.
refundable tax credits are super normal and common. there's a huge program where low-income people get them (EITC), plus various rich people and businesses get them for all kinds of special programs. i don't think it's politically or legally tenable to mess around with them in a general way, although Congress or a state could pass a special law targeting altruistic kidney donors, which also seems extremely unlikely.
We find it acceptable to financially compensate women for egg donation. Not sure why tax credits for kidney donation should be controversial. I believe Iran offers direct payments for kidney donation which carries a higher risk of undue inducement.
I wonder what the actual free market value of a kidney would be. Probably much smaller than $100K because there's plenty of people desperate enough to do it for $10K... although many of these people would have issues (drug addiction) that would disqualify them.
Not sure. I know we pay $7-10,000 on average in the U.S. for egg donation. In Iran, I believe they pay $4000 for kidney donation. I bet it would be a lot higher in the U.S. but probably not $100K. The other question is who pays? The recipient or the health insurer?
I guess it's because egg donation isn't life-saving, and kidney donation is life-saving, and you can't financially incentivize people to do good things . . ?
More likely the reasoning is that egg donation doesn't intrinsically endanger the donor's health... though holding to such a principle consistently would also ban employers from offering hazard pay for riskier jobs at the same skill level.
That and the fact that taking eggs from a woman doesn't impact her ability to produce eggs in the future. A better analogy to kidney donation would be donating an ovary.
Have you found scientific studies which show that the phenomenon of being reduced to only one kidney continues 30+ years after donation?
FWIW the linear no-threshold model of cancer risk from radiation is strongly countered by parts of the world which have much higher background radiation, on the order of the 30 millisieverts you avoided but every single year, and they don't appear to have elevated cancer risk. Similar with airline pilots.
> In polls, 25 - 50% of Americans say they would donate a kidney to a stranger in need.
> This sentence fascinates me because of the hanging “would”. Would, if what?
The answer is a mix of "if they were introduced, perhaps in a superficial 21-minutes-plus-commercial-breaks documentary fashion, to a particular stranger, who was sympathetic and in need of a kidney" and "if it was 'call 1-800-KIDNEYS and book an appointment sometime in the next month, have the surgery and spend a day or two in the hospital recovering' instead of... well, the entire ordeal you describe, minus UCSF's psychiatric proclivities.
It's also a pretty upper-middle-class sort of thing to do, and I think a fair amount of the people answering "yeah, I'd donate a kidney" never have to really seriously consider the question, because if you're not in a position to take a bunch of time off work and life to go fuck around with hospitals and Zoom conferences and piss jugs and then, on top of all that time, take a solid uninterrupted block of time off work and life to go have the thing yanked out and recover then it's really not something you can ever seriously really consider. Not at all trying to sound "check ur privilege, white kidney-donating male" or scoldy. I just mean it in the sense that it's similarly easy for the fox to say he'd easily resist the temptation of the grapes even if they weren't hanging ten feet overhead.
I worry that the Coalition To Modify NOTA is composed to people who are too nice to think of this, so this suggestion might do good: include a provision that the tax credit will not be INCREASED for, say, twenty years. (I don't know if the government is capable of making such long-term commitments though.)
I was wondering if you've considered getting on the bone marrow donor registry, and if you could write about that at some point in the future? Two years ago at the age of 26 I was diagnosed with acute lymphoblastic leukemia. It's the most common childhood cancer, and one that is highly curable in children, but has a mortality rate that increases sharply with age - my prognosis at the outset was about a 60% chance of surviving five years.
For me, and people like me, our best chances at a cure depends on a bone marrow transplant. Leukemia is a cancer of the bone marrow, so the surest thing to do is use chemo and radiation to obliterate all of your bone marrow, and then replace it with a stranger's who doesn't have cancer. But since your bone marrow makes all of your blood, including your immune cells, putting any average Joe's marrow in there would just cause your new blood to viciously reject your entire body, basically. So a recipient and a donor have to be closely matched on a variety of different factors to reduce the chances of this happening. This makes getting as many people on the registry as possible extremely important, and this also means that when someone is contacted about being a donor, you are often the only donor available for the recipient.
Unfortunately, I did not have a match on the registry, so my treatment consisted of chemo only, without transplant. I am in remission but my chances of relapse are a coin toss. Relapsed leukemia is harder to treat, and it would increase my odds for survival if I had an eligible donor were I to have to return to treatment. It would mean a lot to me if you would consider signing up for the registry (it's pretty easy) and writing about the experience. Thank you!
Edit to add a couple of things after the fact: I'd also like to say that unlike many with organ transplants, bone marrow transplant recipients don't have an expected expiration date following transplant. As long as the transplant is successful, and the cancer doesn't come back despite it, a BMT recipient can expect to live for most of their natural lifespan they would have experienced if they hadn't developed cancer, minus the added risk of future cancers that come with the chemo and radiation necessary to prepare you for it.
And, lastly, most people on the registry won't ever be asked to be a donor, but if you are, being a donor doesn't come at much cost or risk: there are lots of screening tests to ensure compatibility (no CTs I think), but it's not as intensive as what you went through for kidney donation. The actual donation process beyond screening consists of the hospital just giving you some drugs that stimulate your body to make extra stem cells, which can make you feel gross for a few days, and then using a machine to run your blood through a filter that collects those stem cells before placing the rest of your blood back in your body. It takes a couple of hours and I've heard it's a pretty cool experience! Plus, if you and your recipient both consent, the registry will connect both of you two years on so that you can meet each other.
I think there is not much to write about until you get the to actual donation part. My registry contacted me once about a potential match, asked me to re-submit my swabs, and I never heard about it again. I hope they found a better match for that person.
Yeah, this is a good idea. I've been kind of scared because I heard it was really painful, but I'll just tell myself that it's a low chance of ever getting called up.
It's not painful anymore! In the past it was, they cored your bone to take some of your marrow. But now they just give you filgrastim (I think) and collect the extra stem cells you now have floating around in your blood a few days afterwards.
I had. Don't remember any problems. Compared to the things I do remember from that time that suggests an upper bound of perhaps 4/10 pain lasting seconds, but more likely just discomfort.
FWIW: I have a phobia around tubes-in-my-tubes so catheters are a proudly horrifying idea to me; even IVs are really upsetting. But when I had to have a urinary catheter during and after abdominal surgery, it bothered me much less than I ever would have imagined a priori. Initially, I was feeling too fragile and exhausted and hit-by-a-truck to care -- these are standard postop feels; painkillers help, even if you aren’t in much pain per se, and it passes -- to be able to muster any f*cks, and when I returned to myself a bit more, it was an already existing situation and causing me literally zero discomfort, so I took a deep breath and focused elsewhere. Even removal was pedestrian. *Extremely* sympathetic about Scott’s bad experience with that.
> It starts with wanting, just once, do a good thing that will make people like you more instead of less.
Then consider this my contribution to the world: I think this behavior is about as admirable as men castrating themselves for religious reasons, or Xhosa killing their cattle for religious reasons.
A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
> I asked them if there was anything I could do. They said maybe I could go to therapy for six months, then apply again.
On the other hand, I find this to be even weirder than the post presents it as being. This remediation makes sense if the concern is that your OCD of 20 years ago might be prompting you to make an unsound decision to donate a kidney today. If the concern is that there's something wrong with your kidney, therapy is pretty well guaranteed not to address that.
> A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
Sometimes the money will do that, and sometimes the kidney won't. The judgment you're really making here is "the kidney recipient is more morally worthy than the money recipient", which has not been established.
As someone who's considered donating their own kidney for a few years (not from EAs), but is on the fence about it, I admittedly don't really understand your line of reasoning here, since for my personal decision making it's 'and', not 'either/or'. I also admittedly find your contentious framing not very helpful, maybe you can rephrase in a way more conducive to changing the minds of fence-sitters like me?
> I admittedly don't really understand your line of reasoning here, since for my personal decision making it's 'and', not 'either/or'.
I'm not really sure what the contrast you're drawing is. I was drawing a contrast between people who pressure you into injuring yourself financially ("bad") and people who pressure you into injuring yourself physically ("good"). I'm not sure what the opinion of society in general would be about a group that pressured its members into doing both of those things, but I suspect it would lean toward "bad".
My objections here are stronger than, but similar to, one of my main objections to EA in general: I don't think it's a good idea to "make charitable efforts" in the abstract. You should have a first-order goal. If an EA's goal is "give to charities that are rated highly by GiveWell", they are just as vulnerable to their donations being wasted as everyone else is, because there's nothing they're actually trying to accomplish. There is no future state of the world that would inform them whether, when they previously donated to a recommended charity, that worked out well or poorly.
So, according to me, your charitable efforts should be directed at things that you think are problems. The tycoon who funds high-powered basketball contracts for his local team is concretely addressing a problem that he can perceive (and that other people in his community share!). He counts as more charitable than the person whose goal is "donate to the proper charity, whichever one that is, I'll ask someone else".
If your advocacy for kidney donation is based on your need for a kidney, or your personal scars left by a loved one who needed a kidney, I will call it admirable. If you do the same advocacy because you think calling on other people to donate kidneys sounds like the type of thing you should do, I will call it reprehensible.
And similarly, if your donation of a kidney is motivated by the need of someone you care about, I will call it admirable, but if your donation of a kidney is motivated by the need of someone you've never heard of, I will call it stupid.
Your comment reminds me of something I read (I forget where) denouncing "nonempathic altruism." The point was that you ought to CARE about the people you're supposedly trying to help.
> The point was that you ought to CARE about the people you're supposedly trying to help.
But I don't agree with that point. I'm saying you ought to be trying to solve things that are problems for you, and you shouldn't be trying to solve things that aren't problems for you. There are two primary reasons: (1) if you follow this policy, you will be able to tell whether the problems are getting better or worse; (2) the fact that you personally have a problem serves as evidence that at least one person has a problem.
This may intersect with your interpretation in that, if you care about the people you're supposedly trying to help, then their suffering is a problem for you. But the analysis is different. Note that I called advocacy reprehensible (you are setting out to hurt other people) and donation stupid (you are hurting yourself). By my reading of your comment, you think I'm calling donation reprehensible.
If Scott had met the recipient beforehand, would that make a difference? Even if the meeting was solely because of his prior decision to donate? What about if he had the option of meeting the recipient, but for some reason it didn't happen?
Do you have to know them in advance? I've volunteered at a place that feeds homeless people. I knew no one involved when I started, but got to know a few people while doing it. In a way, it was a sacrifice of my time, which is like a sacrifice of my life. But in another way, it was an experience that became part of my life. Perhaps Scott wants this experience to be part of his life.
There was a fascinating EconTalk podcast, almost a decade ago: 2014-07-14, "D. G. Myers on Cancer, Dying, and Living". In it, Myers said something that I think was profound, even though I'm not religious: "[God] didn't *plan* it; this is the history He wanted for me."
> If Scott had met the recipient beforehand, would that make a difference? Even if the meeting was solely because of his prior decision to donate?
To the second question, that would be the difference between trying to address a problem that you have, and trying to afflict yourself with a problem to address. I don't see them as similar.
To the first question, let me answer in a larger scope: the propriety of donating a kidney depends on how strongly you are connected to the recipient. Having met them is not necessary (but would, if the donation were appropriate, almost always have happened) or sufficient.
> Perhaps Scott wants this experience to be part of his life.
That would not be enough to make his decision admirable.
"You don't personally know the person you're trying to help/their scars are not your personal scars" is different from "there is nothing you're trying to accomplish". "Helping people you don't know personally" is a thing one can try to accomplish.
Also, there is no such thing as "making charitable efforts" in the abstract. It requires doing a concrete thing with actual effects, such as picking a particular charity and supporting them. Helping people you don't know is not helping abstract people in some Platonic realm, they're actual people, they just don't happen to be on your list of friends.
Helping only those on your friends list is _very_ limiting. What if my friends are doing OK, but I know that some other people are not? Am I supposed to pretend that those are just stories told by malicious Djinn and the only things that are real are the things I see with my own eyes while personally present, not even a direct video feed counts, because someone might have faked the video? It's theoretically possible that someone might fake any video I see, sure. But I'm not that much of a solipsist. I can even (shock, horror) read a book and believe there's a decent chance the words in it relate to actual things, despite the fact that creating a book that says false things is easier than creating one that says true things. Shockingly, I can believe that the words I read before writing this post were probably written by a real person who will later read my words and be affected by them in some way, even though this is _an Internet comments section_. Admittedly, sometimes I do doubt whether something I read on the Internet was written by an actual person and suspect I'm wasting my time, but for the most part, the conversations I engage in seem worth it. And similarly, sending money or useful goods or services to people I've never met through an organization composed of strangers, based on information written by other strangers about places far away, often just works as advertised, as best I can tell. Sometimes not, but often so.
According to you, my charitable efforts should be directed at things I think are problems. Well, I agree, that's obvious. I just think, like, people dying all over the place in developing countries or suffering because of stupid things that can be fixed for a few bucks _is a problem_, even if I don't know their names. It's a problem I'd like to do something about. And there are means available for me to do that, and requiring me to make new friends first seems like an awful and useless hurdle. And thousands of people waiting on an organ recipient list, is also a problem, and one which there are means to solve. I can see how you might be concerned that someone might spend some money I give them on something for themselves rather than something helpful to the people I want to help, but like, what's the equivalent of that, for kidneys? You can't buy a yacht with kidneys. Most likely if I donate one, the doctors will try hard to make sure it gets into someone who needs one.
Not really, it's more about directness and probability. The kidney goes to a particular person, who has a known high probability of living because a specific thing that was wrong got fixed. The money is fungible, and with regards to "cults", the phrase "hookers and blow" comes to mind.
... Unless you're referring to Effective Altruism as a cult? While there are cult-like aspects to EA, they're also quite good at providing the numbers and math for what the money will do, which in this regard puts them ahead of pretty much every other group out there.
> ... Unless you're referring to Effective Altruism as a cult? While there are cult-like aspects to EA,
Look at Scott's description of his decision-making process:
> my girlfriend ending up begging me not to donate, and I caved.
> When I talked to my family and non-EA friends about wanting to donate, the usual reaction was “You want to what?!” and then trying to convince me this was unfair to my wife or my potential future children or whatever. When I talked to my EA friends, the reaction was at least “Cool!”. But pretty often it was “Oh yeah, I donated two years ago, want to see my scar?”
> After I submitted the donation form, I was evaluated by a horde of indistinguishable women.
> they all had questions like “Are you sure you want to do this?” and “Are you going to regret this later?” and “Is anyone pressuring you to do this?” and “Are you sure you want to do this?”
On the one hand, you have everyone close to Scott, plus the impersonal medical system, stressing that this is a bad idea and he shouldn't do it. On the other, you have a group of erratic weirdos who like to talk each other into following through on bad ideas, and they provide support, encouragement, and role models for this one.
One could say the same thing about a group of slavery abolitionists 200 years ago.
Also, I wouldn't characterize the impersonal medical system as saying that it's a bad idea. I take those questions literally. They're important things to ask. Sure, it sets off our social sense because the same questions can be used as code for "this is a bad idea and he shouldn't do it", but the context is different.
> One could say the same thing about a group of slavery abolitionists 200 years ago.
I'm not sure what "the same thing" refers to. That they were a cult? That their characteristic behaviors were due to pressure from other abolitionists? That they liked to talk each other into following through on bad ideas?
I don't quite see the parallels there. It would be easier to say they could also be described as erratic weirdos, but I don't really see that as a central theme of my comment above. I included that to form a closer parallel to the paradigm of "cult".
Yes, one could, and I WOULD, say the same thing about slavery abolitionists. And about vegans. And about abortion abolitionists. And libertarians and anarchists. And men's rights activists, and white civil rights advocates. (I made sure to list a few causes I personally support.)
There are many causes that seem (and therefore ARE) righteous to those on the inside while simultaneously insane and/or evil to the vast majority outside.
> Also, I wouldn't characterize the impersonal medical system as saying that it's a bad idea. I take those questions literally. They're important things to ask. Sure, it sets off our social sense because the same questions can be used as code for "this is a bad idea and he shouldn't do it", but the context is different.
Note that this argument is incoherent. Those questions are not important things to ask, unless the action they apply to is recognized as a bad idea. If the cashier at Taco Bell made sure to ask whether you were being coerced before ringing up your order, it wouldn't be possible to explain that by invoking the idea that the question was important to ask, because, obviously, it isn't. Instead, we would explain that by reference to the cashier being mentally unsound.
The premise that asking the questions is important already assumes that the course of action is a bad idea.
"A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?"
Because you're not handing it over TO the cult, duh.
I agree, because the leaders of this movement are installing 90% of donated kidneys into themselves, gaining the ability to filter spacetime itself.
For most people, the problem with giving your money to the cult is that it flows into the pockets of the charlatan at the top rather than toward any sort of greater good. Perhaps you find altruism in general to be a repellant concept; this certainly seems to be the case from subsequent responses. You claim to advocate for altruism that solves some defined problem. Yet Scott's kidney was successfully implanted in someone who needed one. That's a definite, concrete change in world state, unlike giving money to a broad, generic 501(c)(3).
But at least this post was silly enough to get me to register.
I think you genuinely hold this opinion, but are also a troll.
> A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
It is not plausible that you cannot independently grasp the differences between, on the one hand, 'enrich a cult's leaders and finance its activities' and, on the other, 'save the life of a stranger' -- nor that you do not understand why, for Scott and most of his readers, these differences are morally decisive.
I'm sure you really do hold values that render altruistic acts like this contemptible, groups that encourage them reprehensible, etc. etc. But you chose to express this opinion, which would necessarily be rather inflammatory in this context even if posed thoughtfully, by... tossing off a couple of insulting analogies (which you know are insufficiently analogous to kidney donation to illuminate anything but your feelings), followed by a rhetorical question that could not be posed in good faith by someone who had spent more than 5 seconds thinking about it.
Everyone else, please consider following the ancient wisdom and Not Feeding The Trolls.
> It is not plausible that you cannot independently grasp the differences between, on the one hand, 'enrich a cult's leaders and finance its activities' and, on the other, 'save the life of a stranger' -- nor that you do not understand why, for Scott and most of his readers, these differences are morally decisive.
This is an interesting contrast with my response to MoonMoth, which he didn't agree with:
> The judgment you're really making here is "the kidney recipient is more morally worthy than the money recipient", which has not been established.
You've come along to argue much more forcefully that what's important to you is that the money recipient is not worthy and the kidney recipient is. That still hasn't been established.
I am noting that the harm suffered by the victim is worse in the scenario we're being called to admire than in the scenario we all politely agree to vilify, and that this is incongruous.
> But you chose to express this opinion, which would necessarily be rather inflammatory in this context even if posed thoughtfully, by... tossing off a couple of insulting analogies
When someone makes a big public announcement "I've started cutting myself. My parents don't like it, but I'm doing it anyway because I want the public acclaim" ... when could possibly be a better or more appropriate time to respond with public condemnation and scorn?
> a couple of insulting analogies (which you know are insufficiently analogous to kidney donation to illuminate anything but your feelings)
This I just see as wishful thinking on your part. They're close analogies. They're not exact analogies.
I think the concern is that OCD can cause obsessive thoughts like not being good enough and needing to do more, scrupulosity, which seems like a bad reason to donate.
I found your very first blog by accident when a book review on native indians you wrote became famous, I read it, loved it, and then went to the first of your posts on that blog, where you described a hike after finishing high school. Loved that and then never stopped reading your stuff since.
Yup. Scott's awesome. I'm an occasional reader and a big fan. Brilliant, funny, knowledgeable, kind, about as honest as one can be in the world of online opinionating and usually correct as well.
Out of curiosity, why? My prior is the opposite (assuming you mean general anaesthetic) so I am metasurprised by your surprise. But I don't know the numbers.
But seriously, I had some broken bones as a kid, and so had my best friend, and then many people I knew growing up (some similar to what Xpym describes, dumb mistakes resulting in unpleasantness) had various surgeon encounters. So I grew up with a prior "most people have been in an OP".
And whose parents don't get swindled to put their 17.9-year-old under general anesthesia to remove ONE wisdom tooth "while your insurance still covers it"?
Several years later, we all learned that wisdom teeth can just as easily be removed under under local anesthesia.
This makes me wonder if this is a UK-US distinction. A quick bit of Googling suggests that indeed general anaesthetics administered per capita per year is on the order of two times larger in the US than here in the UK.
I avoided any medical interventions until my forties when I did have to be sedated under general anaesthesia for an endometrial biopsy. One of my siblings, on the other hand, was sickly from a baby onwards and had several hospital stays. Luck of the draw, I guess? 🤷♀️
I didn't have it until my first colonoscopy. I've also never been hospitalized except for one overnight where it was possible I had had a heart attack but it was acid reflux, which, for those who haven't had the severe form, feels like getting kicked in the stomach.
1. How do you know it was zoom doing it? Maybe they were spontaneously donating body parts and replacing them with UCSF insignia.
2. The Pros and Cons chart is flawed. It weights each factor equally. I, for one, definitely value some more than others. Cornell may not be on top after all.
3. "previous living kidney donors" sounds more Halloweeny than was probably intended.
"I make fun of Vox journalists a lot, but I want to give them credit where credit is due: they contain valuable organs, which can be harvested and given to others."
"I practiced rehearsing the words “I have never donated to charity, and if I did, I certainly wouldn’t care whether it was effective or not”."
"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."
"I had an unusually hard time with the catheter - the nurse taking it out frowned and said the team that put it in had “gone too deep”, as if my urinary tract was the f@#king Mines of Moria"
I didn't read as far as the 4th section (and shame on you for tricking me into reading what I'd avoided! 😂) but when I read the first one I laughed out loud and wamted to share that but had no other comment to make on it.
I recently came across one of his corrections that read something like, 'whole I agree that (x y z)... saying that Vox isn't absolute garbage may have been overstating it'.
I started typing a comment but I realized it would be so long I might as well work on a "Contra" style article for "Why you should not donate a kidney".
If you are a person that's seriously considering donating a kidney please consider contacting me at george @ cerebralab . com -- so that I may try to dissuade you.
I think this would help me write a better article by having a motivated adversary with skin in the game.
P.S. In case Scott is reading this I'm obviously *not* claiming that donating a kidney isn't an altruistic act. I think that you are a fantastic person as always for doing this, I am just against encouraging people to do it because the uncertainty around outcomes seems immense and potentially bleak. Which still means that on-average you saved QALYs and contributed to social cohesion making you an all-around good person for doing this.
P.P.S Hopefully no new rules around posting emails in comments, if one exists and I'm breaking it, I'm sorry
How transferable is the 'kidney credit'? My wife is at elevated risk of someday needing a kidney, so I always figured I should keep my spare in case she needs it. I would be very upset if I gave it to somebody else now, and then 20 years later found myself unable to leverage my past donation to bump her to the top of the current recipient list.
I'm not sure I understand your question. You could always put her as the only person on your list of people you were giving a credit to. But I'm just guessing here - if you're really interested in this, you should contact WaitListZero (link at the bottom of the post) and ask them.
Sorry for the confusion, I missed your footnote #7, it answers my question -- this is good to know! It actually makes it so that if I gave somebody else my kidney now, I could designate my wife at present to be the beneficiary of some other kidney in the future. It's like kidney insurance -- in the event she that outlived me and needed a kidney when I'm no longer around to give her one (or I'm just too old to be a donor) she could get one on account of my having given one away before. Duly updated!
The only thing that bothers me about this is the opioids bit. When my father had issues with a kidney stone, they gave him morphine, and he was in utter amazement of how effective they were, and came out of the experience saying "I can understand how people get addicted to this stuff." I've heard about how people getting their start on opioids because they're prescribed them following surgery.
When I had a tooth extracted(which incidentally also included that kind of lying-in-chair->timeskip->staggering down sidewalk anesthesia experience), I specifically avoided taking the heavy duty pain killers they prescribed me because I didn't want to roll the dice on going down the path of drug dependency.
It's all well and good that it's a relatively safe surgery, but I'm wary of any unnecessary exposure to opioids and would need to know the risks there.
I was looking forward to trying opioids, in a sort of Ulysses-tying-himself-to-the-mast way: I'd heard so many things about them, and wanted a chance to try them without getting arrested.
I joked in the post about how good I felt, but it was actually just a normal amount of pretty good - hard to bother, comfortably warm, easy to drift into pleasant sleep. I tried a higher dose at home when I had my UTI, and had a similar experience, then very unpleasant constipation for the next few days. I currently have a bottle of unused opioid pills on my desk that I haven't touched for a couple of days despite enough pain that I could easily justify it, mostly because of constipation risk. My guess is I'll continue not to use them until the next time I'm in extreme pain for some reason, even though I usually have a pretty experimental approach to medication.
My impression is that happy people without pre-existing mental illnesses or addiction problems rarely get addicted to opioids in the period after a surgery. Partly this is because people with addictive personalities form a separate group who already know this, partly it's because addiction is an interaction between genes and how good your life is, and if your life is good you need to be very genetically unlucky. Partly it's because you'd normally need higher doses, faster-acting chemicals, and longer timespans than a typical post-surgical course to get addicted. And if all else fails, most people won't have the energy/interest/knowledge to find a new source after their prescription runs out.
I think all of this is compatible with the extent of the opioid crisis. I think I remember seeing some studies that people who die in the opioid crisis mostly aren't normal patients who got post-surgical prescriptions, but the people who stole/bought/cajoled opioids from those patients.
Very similar experience here, minus the constipation. Had several occasions to take them after various surgeries. Warm feeling of calmness and not-giving-a-fig. Zero desire to take them after the pain subsided.
That matches my experience as well, with one difference: I kept taking the opioid as prescribed (as in, take X every Y hours) even though I wasn't in pain (because you're supposed to follow the directions, right?). I ended up stopping because I noticed I was getting very irritable in the hour or so before it was time to take my next pill, and I was looking forward more and more to the warm sunny feeling I would get.
I come from a family with a history of alcoholism, so when I realized I was getting irritable I threw them away out of an abundance of caution. Sure did feel good though.
Oh I absolutely ignored the prescription timing and took it only when the pain became really "not ok" (I don't know... 7 out of 10? I never understood this scale, is the 10 "the worst possible"? how would I know what that meant?). I was worried about sliding into dependency without even noticing it.
I got a few opioid pills when I broke my arm a couple of years ago, even though it mostly didn't hurt if I kept it still. I tried one the first day, and in addition to making the pain go away, it also made my PTSD go away. I promptly stopped taking them and have saved the rest in my closet in case things get very bad,. My prediction is that they'll just sit there and eventually expire. Cannabis isn't as effective, and has more side-effects (the whole "stoned" thing), but also is easy to acquire where I am, and has much less potential to be addictive.
But now I have a suspicion about why heroin and Vietnam were so associated.
> When I had a tooth extracted(which incidentally also included that kind of lying-in-chair->timeskip->staggering down sidewalk anesthesia experience), I specifically avoided taking the heavy duty pain killers they prescribed me because I didn't want to roll the dice on going down the path of drug dependency.
When I had my wisdom teeth out, they told me to take Valium beforehand.
Not for any medical reason. It would have provided no benefit at all. But my father didn't know that and he said I should take the Valium because those were the instructions.
My mother, a doctor in an unrelated specialty, supplied her opinion that the Valium had no purpose, and I didn't take it.
But I experienced far more anxiety over the prospect of being forced to take Valium than I did over the concept of having my teeth extracted.
As you might gather from my comment, I am still outraged about this.
I suspect the reason they told you to take Valium beforehand was to keep you from being too nervous about the procedure. The same thing happened to me when I had difficulties with an IUD installation, and I took the Valium, and I thought it was a good thing in that it helped me be calm and easily compliant going into the procedure.
Obviously if the idea of taking Valium causes you more anxiety than getting your teeth extracted than you shouldn’t take it; but I think it’s a good thing that it’s offered, (better if it’s offered with a better explanation!), just to help you actually show up and let yourself be strapped down to be cut into.
> but I think it’s a good thing that it’s offered, (better if it’s offered with a better explanation!)
That's the thing, it wasn't offered. No one said "do you want to take some Valium before the procedure?" Instead, they gave me Valium and directed me to take it.
I didn't take the Valium, but in order to do that I had to specifically violate medical instructions. I opted into a choice that was notionally forbidden to me. I don't find this acceptable.
You really don't think there's any difference between an offer and a command?
I think it's a little silly to treat a painkiller as a "command" having any authority. It's pretty obviously something that's prescribed as needed and clearly intended as optional.
I've taken opioids after major surgery. Their effect on me was to dial down the pain from a full boil to a simmer. That's it--no psychological effects of bliss or euphoria. Now, I was taking the prescribed dose, and probably if I took a lot more the effect would have been different. Once I healed a bit, I had no problem stopping taking them, and in fact still have a bottle of oxycodones in the back of my bathroom closet.
I have had morphine by IV to kill pain from a dislocated shoulder and kidney stones (separately), and didn't particularly enjoy it. It started with an unpleasant, nervous kind of warmth in indeterminate location, which soon faded, taking down the pain with it. The pain didn't go away, but it seemed more like I no longer cared about it.
I have had Norco and Oxycodone, which worked moderately well.
I have had no inclination toward addiction with any of these, which is only, of course, anecdotal, so your experience may vary. I'm not sure taking prescribed medicines as prescribed is "rolling the dice" unless you have some other prior susceptibility to getting addicted. If you feel a need to refill the prescription after the original need for it (such as pain) has gone away, that would be a bad sign.
I took opioids twice in my life. Once, after I got a wisdom tooth out. I was in pain for days, opioids weren't helping, and I took higher doses than prescribed. I felt no effect whatsoever. No high, no anesthesia, nothing. I even powdered and snorted a pill, to no effect. But there was one effect. I must have gone stupid at some point. I pulled out my dissolvable stitches. And then I forgot about it. I remembered that "the doctor will be angry with me" but I could not remember why. Figured, it must be because I ate three weeks of oxys in 5 days. Surprisingly, he wasn't angry. He gave me more oxys, because I guess you get more of the same thing when you say it's not working. But he said to try Motrin, too. One pill of Motrin took the pain away completely in 15 minutes. One. Frigging. Pill.
(Half a year later, I watched a medical show. On the show, a doctor cautioned her patient to come back to get the stitches out or else they'd heal like a railroad... and that's when I remembered that I'd pulled out my dental stitches!)
Second time, I used my dental leftover opioids for an ear infection. They worked this time. Again, no discernible effect on my mental state.
Since then, I got a pilot's license. Heard a few horror stories about how FAA will make you submit a book's worth of paperwork to prove you didn't get addicted to those 5 pills prescribed after a surgery. So I never took opioids since.
Asking doctors for "something other than opioids" is like a secret password to getting them prescribed to you by the bottleful. Skin infection? Here's some opioids! Minor surgery? Here's a month supply! Dental nerve dying pain? Here you go, to take the edge off on your 6-hour drive to your root canal referral. My apocalyptic meds tote is 60% unopened opioids and 40% every other prescription I hadn't finished. I once told a doctor that I haven't been taking my opioids because they rolled out of the brown baggie and got lost in the car somewhere... so he prescribed me more!
I don't think I would donate my own kidney, due to various emotional reasons none of which are all that thoroughly-considered... but I would gladly vote in favor of the tax credit. That seems like a rare free lunch in national economics. I hope it gets traction.
Speaking of traction, glad to hear you're on the mend, and great write-up.
Soo, do journalists finally get to claim that AE is a cult that steals people's organs?
ALT
Simpsons did it first (S10E8).
On a less facetious note, I find the data on the safety of kidney donation incredibly unconvincing. Vast majority of donors are elderly and have shared the lifestyle of the recipient for decades (stereotypical old couple situation), so tons of confounders and no good data for young people donating. To handwave a safety signal as genetic confounding is incredibly disingenuous when you have no good data to suggest this link, i.e. can't pinpoint the gene responsible.
In general, I find myself wishing sometimes transplant medicine would just, dunno, go away. The results I see in my daily practice are always crap (I am the person who gets to stare at the nice little pictures you had taken all day long). It's far from the miracle everybody thinks it to be, and certain subpopulations might actually be worse of getting an organ than without it. There are practically no randomised trials on transplantation, and the devil kidney in me tells me it's because transplant docs know well enough that it would fail when actually trialled in today's population.
The ethics is fraught with foregone conclusions and false causality (people don't die from a lack of donor organs - they die from their illnesses - yet this language is routinely used by patients and their families: I was recently told by an acquaintance her grandfather had "died because no organ was available" - no seriously eff this gramps died of his alcoholism and two packs a day you delusional excuse for a granddaughter - he was my neighbour). If we are to believe all democracy becomes gerontocracy in the end, I get the heebie-jeebies when thinking about what a government seriously committed to placating the elderly would mandate in that respect.
I hope for your sake this turns out fine, lotsa people with only a single kidney end up as old geezers, but I can't help to think the "advertise kidney donation like blood donation to everyone" moment is a greivous error in the long run and this will fall medicine on its feet colossaly in the years to come. In the short term, this article has demonstrated to me that this blog now espouses values so far from me and mine own that it's probably time to stop reading it.
"To handwave a safety signal as genetic confounding is incredibly disingenuous when you have no good data to suggest this link, i.e. can't pinpoint the gene responsible."
I think this comment ignores the past few decades of genetics. Figuring out the percent of something which is heritable is vastly easier than figuring out what genes are involved (it's never "the gene responsible", it's usually a mix of hundreds or even thousands). Still, when we do get polygenic algorithms, they've shown that the simpler gene-agnostic methods we used earlier to estimate heritability were right.
Although I agree it's unfortunate that you can't do RCTs for kidney transplantation, statistically adjusted studies continue to show the 5- 7 year lifespan and 20% quality of life gain. Before-and-after surveys of the same people also show the 20% quality of life gain, and people say they feel much healthier. There are obvious practical downsides to dialysis and everything we know about it biochemically suggests it should work less well than a kidney. AFAIK every group of nephrologists and medical evidence-setting body agrees kidney donation works better than dialysis. See for example UpToDate, https://www.uptodate.com/contents/overview-of-the-management-of-chronic-kidney-disease-in-adults, ("Kidney transplantation is the treatment of choice for ESKD. A successful kidney transplant improves the quality of life and reduces the mortality risk for most patients when compared with maintenance dialysis") and this paper by the National Kidney Foundation: https://sci-hub.st/https://pubmed.ncbi.nlm.nih.gov/18256371/ . Curious if you have any links or evidence supporting your position.
"People don't die from a lack of donor organs - they die from their illnesses" sounds incredibly facile to me - not just "guns don't kill people, people kill people" facile, but "that person didn't die because of the gunshot, he died of blood loss" level facile. Just say that the result of getting one extra organ would be to save one extra life over the counterfactual.
My understanding is that people who are extremely old and decrepit are considered lower down on the list for transplants than everyone else. My grandfather, who was pretty old when he got ESKD, AFAIK was never even told to consider the options.
I agree that we seem to have some pretty irreconcilable value differences.
The main thing we learned from the last decade of genetics is that neither of these methods work. The few diseases that have a strong genetic contribution are practically monogenetic (ApoE4, PCSK9, ...). Whenever a study reports these minimal point estimates for hundreds and thousands of genes, that is essentially the result you would get from a non-genetic disease: hundreds and thousands of genes that minimally contribute to or detract from the overall resilience of the organism. Don't tell the geneticists, though, they'll get upset because they'll loose their funding once the agencies figure it out.
There is a actually a very straightforward reason for the autoimmune kidney disease they found: surgery introduces antigens from the kidneys to the bloodstream, thereby causing immunisation. The mechanism would be the same as in sympathetic opthalmia, where immune-privileged antigens from the intravitreal space get introduced to the immune system at large by trauma or surgery and then cause an autoimmune response to the entire organ system, eventually destroying both eyes. Replace 'eyes' with 'kidneys' and 'vitreal' with 'tubular' and you got yourself a deal, mate.
Re quality of life or survival gains: this is flawed evidence on all levels - without an RCT, the Ioannidis principle comes to mind: in a null field, observed findings are a measure of the prevailing bias. Control groups are likely sicker or historical, i.e. generally worse off. Also, my claim wasn't that this is a negative for all involved or even on average, but that selected subgroups may be worse off with a donor organ. This changes the calculus quite a bit from a medical perspective (you wrote so eloquently about that a few years ago re/ death risk from seroquel), but since no reliable data is being generated, nothing will change for a decade or so at least. When transplantation goes awry, the disease is blamed. When it goes well, the surgery is credited. This is as embarrassing as it has been effective in cementing the practice.
Finally, the argument is not as facile as you would like it to be. There is no moral causality between the availability of donor organs and deaths. Were there, then everybody who is currently keeping their two kidneys for themselves would be a murderer (or whatever your term would be for "person who is obligated to help but doesn't, thereby causing death"). This obligation doesn't exist, though, and previously this was an accepted view amongst medical ethicists. Since the explosion of utilitarianist bullshit in the wake of Singer's success in the academy, this slowly changing, and I dread to think where it will lead us.
I do not think one can compare donating a kidney to someone who needs one to dying of blood loss instead the gunshot. Would you say someone died of cancer, or because we haven't yet found a cure for that cancer?
I do see the point in saying an illness (such as a faulty kidney) killed someone, rather than saying lack of a donor killed someone. The second phrasing seems to me to take away some of the altruistic sense of the kidney donation, making it more of a duty of a donor instead of a freely offered gift.
"The ethics is fraught with foregone conclusions and false causality (people don't die from a lack of donor organs - they die from their illnesses - yet this language is routinely used by patients and their families: I was recently told by an acquaintance her grandfather had "died because no organ was available" - no seriously eff this gramps died of his alcoholism and two packs a day you delusional excuse for a granddaughter - he was my neighbour). If we are to believe all democracy becomes gerontocracy in the end, I get the heebie-jeebies when thinking about what a government seriously committed to placating the elderly would mandate in that respect."
I don't know, friend; I had a cousin who got a donated kidney and indeed would have died without the transplant operation. He did die several years later, so you could argue that the gain wasn't worth it, but how do you decide the value of "lived extra years to see his children reach adulthood"?
My late father, for reasons we never got adequately explained (I personally think it was due to side-effects of medication) underwent drastic collapse to the point that he had to be resuscitated three times in hospital (and my family was asked, after the first time, did we really want this, with the heavy-handed implication that we should just let him die; my mother refused adamantly to consider this) and was put on dialysis, and eventually sent home from the hospital with the clear, on their part, expectation that they were sending him home to die. He was in his seventies at this stage, so they were going by "well he's had his life, why drag it out?"
My mother and I nursed him back to health, to the point where he was able to be active once again, and was doing so well on dialysis that the hospital considered cutting him down to only once a week (the consultant referred to him as "my miracle man" when doing rounds with medical students, our opinion on that was "yeah this is only because we stopped you guys letting him die"). His eventual death was not due to the kidney problems but a stroke brought on by blood clot due to venous embolism which the casualty department (emergency room) didn't recognise and sent him home with a "sprained ankle". By then he was just starting his eighties, starting to decline, and very lacking in motivation since my mother's death. He was ready to die by then, but he had an extra decade of life because we didn't obediently go along with the hospital about 'let him slip away' the first time.
So while there definitely can be too much intervention where a natural death is better, there's also the opposite where people who could have good remaining years are written off too early.
I will keep reading, but I also definitely realized that Scott's values are dramatically different from my own. But for me, it comes down to the fact that if I'm going to mutilate myself, it has to be a warm decision, and not an output of cold rationality, that is, the kidney would have to be donated to family or someone I love. I mean, I signed the Giving What We Can pledge, but compromising bodily integrity for the sake of a stranger just seems wrong.
However, I wonder if every monastic of every religion in the world could be persuaded to do this, as this would be, after all, consistent with their principles. A quick search suggests this would be 11,000 kidneys, which is nothing to sneeze at.
Flattered to have caught your interest, however briefly. You have mentioned you have traditionalist friends, which is really interesting. You ever tried to read Rene Guenon, who is along many axes the anti-thesis of everything you believe? He is not hateful though, don't get it twisted, even if he believes everything since Descartes has been a mistake.
Basically, he believes the only possible way a civilization can work is in a traditional manner: spirituality, a legitimate spiritual tradition, needs to be at the very core of the civilization. The last time the West had this was in the Middle Ages, and it all started falling apart with Descartes, till we got to the present day, where spirituality is marginalized. He believed the East to be superior to the West for this reason, though he did not get to see the secularization of China and India.
Along all that there is also the perennialist project: to show that all the various spiritual traditions are actually in agreement in fundamental matters, which does not mean on morality (he regards that as secondary to all this), but rather, on actual metaphysics, truths from beyond.
I really like the work of the perennialists actually: the properly spiritual view is to see the harmonies, or at least, don't let the differences make you think there is an irresolvable conflict.
I just wish to say that I am unironically very inspired by "Everything else I try to do, there’s a little voice inside of me which says “Maybe the haters are right, maybe you’re stupid, maybe you’re just doing the easy things. Maybe you’re no good after all, maybe you’ll never be able to figure any of this out. Maybe you should just give up.”"
If fucking *Scott Alexander*, possibly the smartest guy I know of, who is constantly genuinely trying to get to the truth and do the right thing, feels that way, well, fuck it. This is just dumb. I thought maybe I felt that way because…well, because they were right. But there's *no way* that *you* should feel that way all the time, so why should I? Fuck that.
Thank you, genuinely, for being you and allowing us to see who you are.
Seemingly we have saints who are patrons of kidney patients (there's a saint for everything!)
First, St. Benedict of Nursia (*the* St Benedict who founded the Benedictines) whose connection seems tenuous; it may have been (pace the British Association of Urological Surgeons) because a king went to Monte Cassino to be cured of bladder stones, or (pace a Catholic website) because his monastic rule was so harsh, the monks tried to poison his kidneys by giving him tainted food and drink:
"Saint virgin and martyr Marina (Margarita) of Antioch in Pisidia (255-270) is recognized as the patron saint of kidney sufferers and the protectress of nephrology. Beginning in the 13th century she heals in particular patients suffering from nephropathies, pregnant women having a difficult childbirth, barren women and sickly children. She protects the patients from every side effect and complication. Saint Marina is represented in hagiography as a victor, defeating the dragon Satan, holding a hammer or a cross and wearing a belt around her back in the area of kidneys. According to writers, artists and sculptors the belt is the perceivable means of Saint Marina for the miraculous recovery from and healing of kidney diseases. Therefore, kidney sufferers and pregnant women put belts upon her relics for blessing and then wore them. From the Middle Ages and Renaissance and up to the contemporary period Saint Marina (Margarita) was considered the patron saint of kidney sufferers. Justifiably she is recognized by the modern medical world as the protectress of nephrology."
> This request didn’t get communicated to the surgeon and he told me anyway - but luckily everything did go well.
Perhaps the surgeon actually did receive the request, and violated it only because the recipient lived.
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In countries where it is harder to sue hospitals than it is in the US, are decisions like UCSF's re: OCD less common?
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Do any kidney-transplanting hospitals publish their full list of medical conditions which rule out a potential donor, either due to risk to the donor from the surgery, or risk to the recipient from a potentially subpar kidney? I would appreciate seeing one.
> Perhaps the surgeon actually did receive the request, and violated it only because the recipient lived.
I suppose the game theoretical problem is ameliorated because no one (?) donates kidneys more than once, so there's never a chance to figure out an individual doctor's pattern of behavior.
I knew someone with 3 kidneys, at least they said so, but google says there are only 100 cases globally so now I am suspicious. But possibly one of them could donate 2 times.
The Linear No-Threshold Hypothesis of radiation says that every milliSievert increases your cancer risk. It does not. Humans cope and even seem to thrive with a background level of radiation. Prof Richard A. Muller (the Physics for Future Presidents guy) has thoroughly debunked LNT. That the NIH supports it is further evidence that it is nonsense.
1. Without saying outright that I trust the NIH more than I trust some person who is "the Physics For Future Presidents guy", I don't trust the Physics For Future Presidents guy *so much* more that I will totally ignore the NIH's view and not even consider it at all.
2. 100 mSv has been empirically demonstrated to increase cancer risk, so if there's a threshold, it's there or lower. The CT I was worried about was 30 mSv. So to not worry about the CT, you would have to claim both that NIH is wrong and there is a threshold, and also that the threshold is definitely between 100 mSv and 30 mSv (and not, say, 10 mSV). I don't really see any evidence for that, so even if there is a threshold, I'm worried the test might fall above it.
The probability calculation of 1/660 doesn't seem at all correct to me. Every Sievert, you say, raises your risk of dying of cancer by 5%. But that's raising it from *whatever the current rate is*, which is... okay, a quick google says that cancer mortality in men is something like 200/100,000. So 30 milliSieverts would raise your risk by a total of 200/100,000 * 1/660, which is more like 1/330,000. (Or, I guess, raises your cancer risk by 1/110,000).
Came here to make a similar point.The linked article says "5% excess risk of death from cancer" and then has citations I can't reasonably follow; I can't tell whether that should be understood as (5% excess risk of death)(from cancer) [i.e. the cancer risk amounts to 5% increase in all-cause mortality] or (5% excess risk of) (death from cancer).
More glaringly, Scott writes:
"the risk of dying from the screening exam was 1/660. ... I regret to inform you she might be right. ... a 30 mS dose increases death risk about one part in 660."
Two very different statements! Does the scan have a 0.15% chance of leading to your death, or does it increase your odds of dying by 0.15%? The former seems crazily high, but contextually it's being compared to the risk of surgery, where the figures really are about the risk of the procedure killing you.
Anyway, Scott, if you see this, congratulations and good on you - just want to make sure you're not unnecessarily making kidney donation sound scarier!
Huh. I admit I didn't look super closely at the citation last night -- I looked a bit at them this morning and they are hard to follow, though I *think* they might actually mean that they do think a 30 mS dose could give a risk of dying of 1/660. What I mostly came away with is thinking that 30mS is a rather high dosage of radiation -- everything in the chart in the article is much less than that. (Also I came away with the idea that... no one really knows, actually.)
And yes, I forgot to say, congratulations Scott and I think that's really great!
> You don’t need to worry about not having a kidney when a friend or family member needs one. When you donate, you can give the organ bank the names of up to five friends or family members who you’re worried might end up in this situation. In exchange for your donation, they will make sure those people get to the top of the list if they ever need a transplant themselves.
This was certainly news to me, and makes me feel better about the whole thing, but doesn't the fact remain that your own kidney is much likelier to be a better match for a family member than some other kidney off the list?
I don't know. It's true that your kidney (because of genetic relation) is much better than average. But it might not be better than the best kidney available to the organ bank with hundreds of kidneys available. (I don't understand how this works well enough to be sure it works like this). It also seems like in some cases (eg spouse, relative with different blood type), your kidney wouldn't work at all, and the bank would be a better alternative (though usually the bank would let you make some kind of more direct trade).
I also wonder (1) what are the odds that they will actually "make sure those people get to the top of the list"; is there any accountability for this promise? and (2) is there any way for me to pay somebody with a blank space to write my name? (We could call this "The Taylor Swift trade".)
also (3) what about the lost optionality? It'd suck if your True Soulmate only comes into your life after you've made your list, or if someone on your list dies for unrelated reasons. Really they should just give you a fungible "Good for 1 kidney" token (which you could then trade on the open market because it isn't itself an organ!). (Plus, then maybe they could offer 0.9 tokens for a slightly-substandard kidney. )
I found this post somewhere in my newsletter, and i was surprised that anyone would give precious part of the body to a stranger.
I have kidney disease (they dont work anymore to be honest), located in Europe - and here i never heard about 'random' donors.
Moreover, i personally never asked (and probably will not ask in the future) my friends or family for organ donor. Im overwhelmed about idea asking anyone for something that big and important.
Congrats, you make 30+yrs old man to cry like a baby :)
I really wish you everything best and i admire what you did.
You don't mention where in Europe, but depending on country, it might make sense that you haven't heard of undirected donations — they're illegal in France, for example. I am duly furious about this.
I thought about donating in Germany, but they are also illegal here for some reason (I blame Catholics), luckily I could also probably donate in the UK if I ever want.
If this estimate of increased risk assumes the linear no-threshold theory (LNT) -- and a quick look at the cited paper suggests it does -- it's nonsense. Read Jack Devanney's substack on nuclear power, where you will find demolitions of the LNT theory.
My usual admiration for Scott. Even higher than usual if possible. Glad he is alive, was considering open a manifold market: Is Scott in hospital? - Had hoped for an even better reason to be there. And feared for worse - The beginning freaked me out: "As I left the Uber, I saw with horror ..." One of my few wishes left is: May I die before Scott does.
Cheers for NOTA! To keep up the pressure, I shall keep my organs for now. (From an MRI I assume the one kidney is not fine enough to donate, and the fine one I intend to keep.)
It took me a while to register that Scott was giving an accurate account of what was going on in his life rather than offering a thought experiment or a short story.
I AM a naive reader* and accept most the authors may throw at me. Scott's fictional texts signal early enough what they are + while his life stories are so true, it may hurt. Most his posts are non-fiction (esp. if one discounts the bay-area-parties, we know now). And after such a long break from posting, I was ready to expect a story involving a hospital. The Q of my YL has gone up much by reading Scott. So I care.
*I assume nearly all are. To do better, eventually, reading Bryan Caplan may help me: a) Caplan writes some libertarian stuff, I buy it all. b) Caplan gets into a discussion and lets the other side explain their position. I buy this now 90%. c) Caplan writes why he still disagrees with them; I buy 70%, d) They get one last say: Now I am kinda undecided and have to make up my own mind. ;) Right now at stage b) https://betonit.substack.com/p/sehon-responds-on-socialism
I wonder whether a policy to give a tax deduction rather than tax credits for kidney donation could receive less political opposition. Because it seems the main concern opponents of compensation for kidney donation have is that poor people will donate kidneys for financial reasons in a way that seems morally icky. Whereas with a deduction, due to the existence of the standard deduction, the financial incentives would become active at some level of income while not influencing the behavior of people poorer than that, right? Does anybody more familiar with US taxation and organ donation policy know if there's some number at which such a deduction could be set to alleviate the US kidney shortage while not influencing the behavior of the poorest, say, 1/3 of Americans toward kidney donation?
I think paying them the same amount is good. Another person thinks it's bad.
It's like reading two comments on abortion and observing, "Abortion is bad, but banning abortion is bad. You can't win!" Such is life on controversial issues.
I happen to live very near the "castle" and aside from a one week event for college students when they first bought it, it seems like they haven't actually run any conferences there yet over the last two years, but have continued to rent other venues for retreats and so forth since.
Old buildings can be money holes. I suspect, though don't know, that there are either transportation issues (there's a year+ long road closure on one of the main routes there) or maintenance issues that have prevented it from being used for any conferences as of yet. It's kind of a red flag to me that Oxford University owned it but then sold it as they didn't think it was financially feasible to hold on to. Though to be honest I'm glad it's back in university-associated hands rather than as a private building, as the university owns the rest of the adjacent land. It's a lovely area.
It's in Oxford, which is nice if you're a person living in Oxford, or attending Oxford University, or a professor there.
If you want to attract Business People and International Interested Persons, then London is always going to be a much bigger and better draw (same over here with Dublin versus the rest of the country). Easier to get to for most people, has the infrastructure and associated supports and other companies, entities, state and private organisations, and is just the first place someone would think of, rather than trying to get to a nice little historical village outside of Oxford.
I'm fully expecting it to be a money pit and ending up sold off again in a few years. Reading the defences of the decision to buy it, it seems to me to come down to (1) we had a shit-ton of money and no idea what to spend it on and (2) one particular guy was pushing hard for it and seems to have swayed opinion.
Again, I don't think they're bad people, just people of a certain socio-economic class who don't necessarily realise how their actions will look to the general public. Same as Just Stop Oil having a vegan-catered banquet in a (former?) church premises with accompanying harpist laid on - why did people laugh and cheer on the disruption? Because they're working-class/lower middle-class people inconvenienced by the protests blocking the roads when they're trying to get to work, and they certainly aren't going to be serenaded by classical harpists at work:
And of course they look exactly as you'd expect (boots with summer dress) and are humourless: "must be paid by the Daily Mail!"
They want to solve global climate change by stopping oil, which will be easy-peasy to do, everyone just stop using oil - but getting a few balloons down from the ceiling is a very difficult problem, so hard!
Purely anecdotal evidence: I was at a workshop in the castle this month, and the same organizers had done one event there already and were planning to do two(?) more.
Also, a nitpick, as far as I understood, CEA didn't technically buy lent it for the next 100 years.
Kudos to you. Though I am suspicious your evil voice will learn to adapt to the new circumstances, perhaps encroaching on your good voice's turf in the right kidney, or, if the "left" part is important, perhaps claim your left lung?
I looked pretty throughly into kidney donation and even signed up for the first level screening but I ended up chickening out. However, I heard at one point that a screening question that’s commonly asked during the kidney donation process is “do you donate blood?” and I realized it was silly that don’t, given that I was likely eligible and that it’s a much lower risk but also life saving intervention. So I started donating blood and I encourage anyone who’s not quite comfortable with donating a kidney to try donating blood or platelets! The FDA has recently changed screening guidelines so that some previously deferred groups in the US (including gay men who haven’t had a new partner recently and people who have lived in the UK) are now eligible to donate.
Small note: the article you cite from Tom Ash was actually written by Josh Morrison and Thomas Kelly, according to the preface of the post.
Thanks for writing this. I donated as well, and found the experience to be a weirdly effective self-signal. I try to do various altruistic things, from donating money to choosing high-impact jobs, but good signals are costly, and these just aren’t all that costly for me.
That’s probably a bit counter intuitive - what could be most costly than my literal time and resources? That’s all I have! Here’s my thinking: after donations, I still live a life of extreme wealth and comfort compared to the average human, so the opportunity costs of donation are kinda trivial (like, maybe if I didn’t donate, I would buy the new VR headset that just came out, but I don’t suffer greatly because I haven’t done so). As for my job choices, these have coincidentally (suspiciously I might add, in my moments of doubt) been things I find challenging and interesting and rewarding in and of themselves. On top of that, there’s the point you mention that lots of my preferred ways to do good aren’t actually seen as good at all by plenty of critics (and, like, many everyday people too). I’m somewhat prone to imposter syndrome, and it’s easy for me to doubt my own motivations and impact on the world.
Donating a kidney was not only a costly signal of my values (the right balance of costly - annoying but still worth doing), but it also carried a lot of metaphorical resonance for me, since I have a typical secular worldview in which I am nothing over and above my body. Now, when I look at my body in the mirror, I’ll always notice and be reminded that it has a couple faint scars from the time I literally changed it - changed myself - to try to help someone else in a small way. It serves as a reminder that I can do annoying things because I value them, and I can literally change who I am in the process.
This reinforces my identity as someone who wants to do good things for the world, and serves as a healthy reassurance when self-doubt creeps in. So, for strictly non-altruistic reasons related to my general self-image and the narratives I want to tell about my life, I rate kidney donation pretty highly. All the altruism stuff is a great bonus on top of that 😉
Probably, but I don’t see how that’s relevant — the goal of this comment is just to share an unexpected benefit, not to tell anyone it’s the right choice for them on net.
"Also from my spicy [version of the "Effective Altruism As A Tower Of Assumptions"] essay:
Q: All possible forms of assistance, financial and otherwise, just make recipients worse off, for extremely complicated reasons. There are literally no exceptions to this. I promise I’m not just looking for an excuse not to do charity, I would love to do charity, it’s just that literally every form of charity is counterproductive. Weird, isn’t it?
A: Even kidney donation?"
Now that's what I call putting your kidney where your mouth is! (don't eat your kidney)
Castles need TLC as well, such as repointing stonework as needed, and weeding small trees and other foliage growing near or on walls, or even retiling roofs assuming the place isn't a complete roofless wreck. So the group who bought the castle also deserve some credit for maintaining it, assuming they do so adequately, for the benefit of future generations.
> Self-modifying into a person who can act boldly without social permission is a more general solution and has many other advantages. But the long version involves living a full life of accumulating moral wisdom, and the short version starts with removing guardrails that are there for good reasons.
I was vaguely uncomfortable reading part IV - the one about the castles and the fuzzies and the utilons - and I guess this footnote made it clearer why.
Ten years ago, you wrote that "in all situations, the government of Raikoth will take the normatively correct action." In those ten years of life, having accumulated the moral wisdom that you did, would you say you've gotten closer to embodying these words - not in the sense of *knowing* the correct action, not even in the sense of *actually doing* it, but in the *knowing that you know* sense?
My impression is that 2023!Scott is, if anything, more reticent about this stuff than ever. This is a problem when Guardian opinion columnists are constantly whispering dread outside-view incantations in his ear, demanding that he give up his left kidney, and generally holding his sense of satisfaction hostage. That seems even worse than the state of nature, which is getting fuzzies from Meaningful Human Connections™. Those, at least, are fake in an obvious way.
(not that I'm saying it was wrong to donate the kidney; just that this post is pretty depressing, like watching someone fill out taxes, except it's not even a morality tax like the GWWC pledge, it's a tax on *having a morality*.)
What do you mean by saying Guardian columnists are demanding he give up his kidney and holding his satisfaction hostage? I see that as his inner sense of shame and scrupulosity. I agree it is a sad post - I wish he did not need to take such drastic steps to feel worthy.
Hi. CT scans have been around now since the 80s as well.
The whole brouhaha started with Brenner's paper in the AJR in 2001, which was modeled on radiation from Hiroshima and Nagasaki, which itself is not a fair modeling example, because the radiation profile is different and you can't just extapolate the risk from 1000mSv to 1 mSv (CT scan would be between 1-10 mSv). Until then, no one talked about diagnostic imaging and radiation risk.
So the burden of proof lies on those who say that radiation from diagnostic imaging (< 50mSv one time dose) increases risk of cancer, not the other way around. There is no data showing this in adults. Those who believe in the hypothesis have moved to children, where if at all (and no one has accounted for reverse causation), for every 10,000 CT scans of the brain, there is one increased brain cancer risk, that's it.
Modeling is just that, modeling. All of the references below say "There is no evidence that low-level radiation from medical imaging causes harm and below 50-100 mSv of exposure, the risks are too small to be observed or non-existent".
1. Amis Stephen. Radiology 2011: 261: 5
2. Position Statement of the Health Physics Society, Jan 2020
Unlike with so many other medical interventions, where our follow-up data is in the range of a few years (statins is now 35 years), with X-rays we have good solid long term data. Remember that from the 20s till almost the 90s, patients were also exposed to barium studies, IVU studies, where the radiation was in the same range sometimes as CT scans. Some observational study from the NHS or from the Scandinavian countries that track all their patients would have shown some causation. But there is nothing.
Casually bringing up your disdain for journalists in the absence of an occasion to criticize them creates more heat than light and annoys my NYT-reading fiancée
This still gets my hackles up. Let me fumblingly try to articulate and explore why I feel this way, in a way that hopefully sounds valid.
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Let's imagine for a second that this was written by someone other than Scott, someone who I haven't spent years reading, and whose thoughts I don't understand as well.
The text of this article is "I donated my kidney". The message, partly stated but mostly implied, is "You should do so too." (With caveats of "I'm not telling you to do this, just giving you social permission to do it if you were already inclined.")
Most people trying to get you to do something this drastic and unusual don't have your best interests at heart. They stand to benefit in some way or another. That in and of itself is a pretty big barrier to convincing people.
How can someone benefit from kidney donation to a random stranger? They don't have to benefit directly. If they have a value system that thinks your actions improve (their conception of) the world, they'll usually try to argue you into it anyway.
Does this actually improve the world? Probably, at least to some extent. Does that extent justify the health risks?
Scott's a doctor, I'm not. With my limited knowledge, my heuristics are, generally speaking, "Keep things related to body, health, and diet as close to natural as possible, doing medical interventions only when necessary, or where the problems are accumulating enough to justify it." I assume that the redundancy in my kidneys is there for a good reason and am inclined to keep it.
This has had some benefits to me: I have a friend who, during a rough time of his life, went deep down a psychiatry rabbit hole, culminating in a breakdown that left him dependent on benzos and unable to work. While we were talking about his issues, I told him my heuristic, and he admitted that it was probably a good one. That's not a knock on the people that need medications—some people really do need it—but the point is even for something like medication, I usually have to convince myself to use it, and err on the side of avoiding it.
So you say the risks are small. Given that I'm this risk-averse, is your definition of "small" the same as mine? Probably not. The weird testicle thing alone would probably be enough to put me off. I have no idea what could cause that, how hard it is to treat, or what kind of long-term damage it could do.
And that's even assuming you're telling the truth. Since you already have a motivation to argue the side that convinces me to do this—look how many QALYs you can bring to the world by convincing me!—you might have a motivation to lie. Or if not lie, then at least do the subtle not-lies that might convince me anyway, like tell a one-sided story; cherry-pick bad evidence; or ignore, neglect to mention, or handwave away some of the risks.
Then I start wondering: hang on, how far will this guy take this?
"You should do this" seems to imply a moral norm: you're a good person if you do this, you're a bad person if you're not. Is he on the onramp to a moral crusade? We've seen a lot of those in politics lately. He's got all those caveats to his message, but does he mean them? If he does mean them, then for how long? Will he still be as forgiving when kidney donation is commonplace or even expected among his friends or ingroup?
Is he trying to make him and his friends look good, to have him and his friends accepted as the morally virtuous subculture, at my expense?
With that gut reaction firmly in place, I start probing my moral philosophies, against both the weaker explicit message and the stronger potential one. I start thinking of bodily autonomy, and abortion: does this line of thinking imply that it's morally correct for women to bring their babies to term at the expense of their own (similarly likely minor-to-moderate) health risks? If good people are morally obligated to give their own kidney, how much else of their life and literal bodies are they morally obligated to give as well? How much marginal risk or pain is one person supposed to take for a marginal improvement of someone else's life?
And then I come into the comments and argue.
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Okay, taking a step back: this isn't quite how I reacted to this article.
The big reason for that is because, like I said in the beginning, I've been reading Scott for years. I know, to some degree, how he thinks about medicine. I've read some of his writing on moral obligations, which makes me think he's being honest about mostly just sharing his story and giving people who were already on the fence social permission to go ahead and do it.
Because of that, my actual reaction to this article is that it shifted my opinion very slightly, enough to maybe freak out a bit less in the unlikely case that a friend of mine decides to randomly donate a kidney.
I would probably still freak out a little bit, and this article is very far from enough to convince me to do it myself. My heuristics are too strong, and my self-awareness in my lack of knowledge too great. Figuring out whether I even want to do this is not a way I want to spend my time, energy, or health, so I default to "no".
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So why am I rambling about this here? Because I expect that this kind of thought process happens in a lot of people that have a negative gut reaction to EA. I expect it happens almost instantly, and likely subconsciously.
A lot of EA writing is a Rorschach Test.
The gut reaction you have to something like this depends a lot on your past experiences, how much you trust the author, your exposure to Effective Altruism, and how often you've had people try to pull one over on you at your expense. These all feed into your personality, heuristics, and priors. That's why you get reactions ranging from "Nope, you're a crazy liar" to "Interesting, tell me more".
IMO, the only way to reach the defensive ones is to advocate for more common-sense, lower-risk actions whose benefits are more easily explained and apply across different moral systems. I've written about this here:
Though I understand that's probably not who you wrote this article for.
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Anyway I'm glad it went well for you and I'm sure whoever got it from you was immensely grateful.
(And sorry for taking a soapbox to this personal story. It just got the gears turning.)
Despite my ramble above, I can't help but think of another blogger I loved to read, Shamus Young, who was diagnosed with end stage kidney failure in 2022 and died three months later. Actions like yours could have made a difference in his case.
I agree with some of your points, I've definitely noticed that sort of negative gut reaction from some of my more suspicious friends and your explanation makes their reaction make a lot more sense to me. I used to be very all-in EA, but while I admire Scott immensely for having the courage to take a step like this, it's also given me the same sort of gut reaction - the reaction of how far should we take this, and how much against our common sense should we go?
Thanks for your comment, definitely helped my thinking a lot!
> I think of society setting the targets for “good person” a lot like a CEO setting the targets for “good vacuum salesman”. If they’re attainable and linked to incentives – like praise, honor, and the right to feel proud of yourself – then they’ll make people put in an extra effort so they can end up in the “good person” category.
I don't get the "you should do it too" vibe from Scott's article, he did point out that kidney donations are not very effective as far as EA goes. As a person who was kind of on the fence on the decision, I feel like reading this article both increased and decreased my desire to donate (learning that you can put 5 friends and family on the priority list was a big plus). Getting support for the tax credit idea is probably far more impactful than warming up individuals to the idea of donating themselves.
- Veganism has a big lobby which creeps into EA, organ donations don't have that, so I don't think it's fair to bunch them up.
- That there are other articles by EAs criticizing EA practices, and no notable criticism of kidney donations in EA, is a stronger signal that kidney donations are actually a good thing than if there were no articles at all.
Not sure which way the utilitarian calculation goes. The additional ACX time, either now or 25 hence, is probably still fairly valuable, e.g., David Friedman is still cranking out interesting stuff while old. But not sure how to quickly compare intellectual output to additional QALYs now.
Huh, and here I wasn't sure if I was just imagining "haven't seemed to get many SSC emails lately, what's up with that?" Worth the wait - always really enjoy posts about your own life. Skin in the game and all that, now you've Got The Receipts in a very concrete way. Someday if we get excellent generative AI for shows, it'd be cool to dramatize this essay as The Alexander Kidney. Or I'll try to recast you as the hero in Angel Beats!
...which segues into, I can't really imagine spontaneously donating a kidney to a __complete__ stranger? Maybe a family member, probably a friend, definitely a SO, some sort of handwavey Inner Ring calculus involved. Bad experiences with involuntary donations make me react really poorly to bodily-autonomy-integrity violations, no matter the utils involved. (And that was just for hair!) OTOH, being on the standard organ-donor registry that everyone signs up for with their driver's license - yes, of course, it's not like I'll be around to miss them at that point. I think I read somewhere on your old blog that such organ donations went down as cars got safer, actually, and It's A Problem...?
Description of the actual process and surgery...retroactively reassures me I made a correct decision to cancel [other elective surgery], even if in theory there's financial reimbursement available. I do think there's definitely some above-replacement Happy Price which would change my mind - $100k is several years of wages for me, that's Not Nothing, money is fungible - but other illegible costs like time and logistical hassle can't be "repaid". Wonder if there's any potential in streamlining the approval process - does it actually need to be several months? (I also don't understand why homeopathic levels of mental illness would be disqualifying, unless it was of a variety particularly prone to driving rash decisions?)
B: Thank you so much for writing this. This piece is going to reach a ton of people, make waves, cause a bunch of new donations, and probably save far more people's lives than your actual donation did.
I've chatted with Dylan Matthews about this, but there's an *extra* massive reason for public influencers to donate their kidneys. Dylan has probably, no joke, caused hundreds or thousands of extra donations via his articles and advocacy. The actual impact of his specific kidney is a rounding error to the attention he's drawn. I suspect that with your platform, the impact your donation will make is at least 100x the typical donation.
So thank you for donating, and thanks for being vocal about it. And thanks for supporting the Modify NOTA campaign!
First off: congratulations Scott! A tremendous thing to do, and I admire your speaking openly about it and encouraging others to do the same.
The CT scan/risk of cancer struck me as unbelievable! I do try to avoid CT scans on patients younger than 40, but I always put the risk as closer to 0.05% - 0.1% per scan rather than nearly 0.5% as your girlfriend calculated. I did a deep dive into this once for pregnant women and I remember the 5% per Sievert thing coming up there (risk to the fetus of childhood cancers, if Mum gets a CT.) Are we definitely sure this is for adults? I did a quick Google just now and clicked on the usual suspects - Scientific American says "a single CT scan increases the average patient's risk of developing a fatal tumor from 20 to 20.05 percent." WebMD: "the chance of getting a fatal cancer from any one CT scan is about 1 in 2,000." Memorial Sloan Kettering: "0.05 percent, or less than one in 2,000 — of possibly developing a future cancer."
Obviously I would love to see a deep dive into this topic!
A multiphase abdominal CT is 30 mSv, compared to 7 for a standard chest CT, so if the upper end of your number is right for the average CT, my number is approximately right for the multiphase abdominal that I was considering.
1. Kudos on the Vox journalist line, made me genuinely giggle uncontrollably at work.
2. Kind of strange, I've been involved with EA for awhile, donated a lot of my (meager) income to charity, and, given the opportunity, would happily take some risks for altruistic purposes. But I still haven't got past kidney donation to a stranger sounding absolutely ridiculous. You can do something just bloody horrible, slightly dangerous (possibly including a bunch of risks you're not taking into account), not at all fun/ exciting, with lower altruistic cost-effectiveness than working and donating to an effective charity... If the effectiveness calculations looked incredible, I would be at least persuaded that it's a morally good idea, but as it is, it feels more like the kind of socially contagious masochism that EA should be trying to avoid.
3. When I was travelling in Northeast China near the Korea border, I spoke to a cleaner in a cheap hotel. He asked me: "Where are you from?" "The UK", "Ah, can you sell kidneys in the UK?", "No, there might be a black market, but it's illegal", "Ah". Then the conversation ended.
I think people really differ on how comfortable they are with different risks - I'm planning to donate my kidney, but I just can't bear to part with much of my income. I value the comfort and security I can buy much more highly than the health risks of donation. Also, kidney donation is way more fun to me than work. It's weird, you get to go to different places (I learned a lot about which jobs in the area don't require drug testing, courtesy of some guys who sounded like they needed that). I am kind of hoping my work fires me for trying to take time off to donate, because then I will gleefully tell that story in every interview. (Somehow I don't want to quit or be fired, but I don't want to have this job.)
I inferred that he was either considering selling a kidney, or that he was suffering from seller's remorse, torturing himself about the idea that he hadn't got the best deal.
Well, first of all, congratulations! There's kidney disease in my family, and yes my cousin died several years down the line after a transplant, so it doesn't mean you can live your normal lifespan. But without it you'd probably be dead, so better a few more years of life than nothing, right?
"They found 34 extra cases of ESRD (end-stage renal disease, the most severe form of kidney disease) per 10,000 donors who were related to their recipients, compared to 15 cases per 10,000 for donors who weren’t (the difference wasn’t statistically significant, but I think it’s still correct for unrelated donors to use the unrelated donor number)."
I imagine if you're donating to a relative, that means there's already a higher risk of kidney disease in the family, so the risk would be increased. As for the risk for donors overall, that may well be because if you have two working kidneys, and then down the line one of them conks out, the other can pick up the slack. But if you only have one working kidney and it starts to fail, then you develop the problems faster and worse.
But it truly was a charitable deed so well done!
I'll only take this one little pop at the Brits, so the castle was the cheapest option? Perhaps, but did they factor in (1) the bad visuals this would produce, so hampering their efficacy because this will turn off the public from donating to them and (2) how do other organisations manage? Are they all out there renting/buying castles, or do they somehow manage to find some kind of conference centre that won't rip them off? I have a feeling that the British EAs had too high an expectation for what they would find acceptable in a conference centre, and coming across a castle they may have found ways to justify "wouldn't it be really cool if we had our own castle?" Boring, bland, beige big room in a hotel may not be anywhere near as glamorous, but I find it difficult to believe it would be that hugely more expensive. I do feel there has been some creative accounting of the "sure, it *seems* like a huge expenditure, but if you take it that over the next twenty years we'll be hiring conference centres at a cost of £X,000 each time, and you multiply £X,000 times Y conferences to get a total cost of £Z00,000 then by comparison, a one-time purchase comes off cheaper".
Yes, you're not paying £X,000 a go for each conference, but now you have a castle to maintain and upkeep, and that's gonna cost.
"I thought I was going to be able to do a good deed that I’d been fantasizing about for years, and some jerk administrator torpedoed my dreams because I had once, long ago, had mild mental health issues."
That's hard. But on the other hand, you live in America. The most litigious nation in the world. Where cities sue car manufacturers because their cars are too easy to steal (Chicago, Baltimore and New York bringing lawsuits against Kia and Hyundai). I'm tempted to say "well in a sane country, you'd blame the criminals for stealing, instead of blaming people for not making their products too difficult to steal" but that would be unkind?
You could swear up, down and sideways that you really want to do this and you're a grown and sane adult and you are doing this of your own free will, but they have no guarantee that five weeks after the operation they won't get a solicitor's letter looking for zillions in damages because they took advantage of a mentally vulnerable individual. Hence, the magic therapy requirement: it's covering their backsides in case of legal action so they can point to "we required him to go to therapy to make sure he wasn't crazy", not for your or any other potential donors' welfare.
> I'm tempted to say "well in a sane country, you'd blame the criminals for stealing, instead of blaming people for not making their products too difficult to steal" but that would be unkind?
I friend of mine blew up at me for saying almost exactly this. I could see this getting generalized in very weird ways.
I suppose yes, if all other automobile manufacturers have incorporated anti-theft devices and Kia and Hyundai haven't, then they do bear some responsibility.
But cities going "We have too many criminals who can roam freely and do as they like, this is *your* fault" doesn't make the car manufacturers look bad, it makes the state of life in your city look bad.
I think the major divergence of viewpoints here is that Scott knows of the type of people who altruistically donate kidneys, whereas I know of the type of people who made a living out of insurance fraud (hence the lawsuits) 😀
There's an ambulance chaser law firm in my town which makes a speciality out of "Dear me, you tell me you had a trip and fall on badly maintained pavements? As did seven other members of your family? Tsk, tsk, let us sue the local council for their neglect of repairing the streets and road surfaces!"
Well, maybe the local council could afford to repair the streets if they weren't being sued every ten minutes by you guys, just saying?
I was going to say exactly this! They're not concerned with your well-being in some "paternalistic" way, they're avoiding being sued. Most likely, some organ donation program in the state was once sued for that reason and lost, and now the malpractice insurance companies all require this protocol. As a diagnostic, I notice that a program in NYC doesn't have this requirement, and that's likely because nobody has won such a suit in New York state.
I imagine they also didn't give any therapy recommendations for much the same reason Scott doesn't give medical advice/recommendations to queries on here.
If they suggested "do such-and-such a therapy for so many weeks", that'd be catnip for the lawyers. "Why did you recommend my client do this particular therapy? Are you a licenced psychiatrist?" "Well, no, but - " "Aha! Manipulating a vulnerable person! That's another zillion in damages we claim!"
"Here’s a list of countries with the highest number of lawyers per capita:
1. U.S. 1 lawyer for every 300 people
2. Brazil: 1 lawyer for every 326 people
3. New Zealand: 1 lawyer for every 391 people
4. Spain: 1 lawyer for every 395 people
5. UK: 1 lawyer for every 401 people
6. Italy: 1 lawyer for every 488 people
7. Germany: 1 lawyer for every 593 people
8. France: 1 lawyer for every 1,403 people
While it’s true that the U.S. has a large number of lawsuits crowding its courts each year, it barely cracks the Top 5 of most litigious countries in the world. In his book, “Exploring Global Landscapes of Litigation,” Christian Wollschlager notes that the litigation rates per 1,000 people shows that European nations top the list of the world’s most litigious countries.
Here is a list of the top 5 most litigious countries by capita:
I've noticed dozens of typos in Scott's posts over the years but have always felt awkward about bringing them up so I never have. (This is not at all a criticism of his writing; nor do I really care about typos. I'm just the type to pick up on tiny aberrations like that.) I'd feel less weird about it if there were a way to submit GitHub-like pull requests on writing so I could just submit a patch that could easily be merged.
You might find it interesting that some sites do, or at least one that I know of - the online web serial site Royal Road has almost exactly this system where you highlight stuff, make an edit and then there’s a ready way to paste it in the comments with auto formatting.
it was interesting to read about the low risks of kidney donation as well as the thought process you went through. What I am sceptical about is wether paying people for kidney donations would actually be the best systemic solution for dealing with kidney failure. I don’t have numbers on the following and you are probably much better at doing the research on that, but as far as I know most kidney failure is related to other diseases (like diabetes II or hypertension) the genesis if which is closely related to lifestyle/ living conditions and can well be prevented. Do wouldn’t the best systemic intervention be to create living conditions that allow people of all classes to make healthy choices without additional expenses? (like modifying taxes on certain foods or forbidding them once they have been proven to be harmful - like high fructose corn syrup - or reorganising supermarkets and advertisement in a way that doesn’t ruin lives for the profit of certain industries…) Or even investing more money on alternative treatments for infectious diseases that would allow to use nephrotoxic antibiotics less often?
Those are just some naïve thoughts of a European, but I would be curious your prognosis on those interventions vs. paid kidney donations.
Slow chronic kidney function decline is almost universal with aging, as is true of other chronic cardiometabolic problems. How bad it gets, and how early it gets bad, is highly multifactorial and can’t be cleanly ascribed to lifestyle. There is a complex interplay among different aspects of the metabolic syndrome, as well as their best-practice treatments, such that the causality arrows don’t always fall in the places and orientations you might assume. The subset of severe kidney failures that occurs in young people with really obvious lifestyle risk factors certainly exists, and is very visible and salient if you are looking for it. I question whether health policymaking should treat it as the conceptual starting point for thinking about kidney failure management.
I think from the examples you suggest that you aren’t yourself very prone to a punitive gatekeeping mindset, and I don’t want to impute one to you, but I don’t trust broad policy strategy to be developed without one if pursued along these lines. Rather than little tax nudges or occasional judicious ingredient regulations, I foresee non-judicious ingredient regulations (ie, proliferating sweeping bans: as an American who is now German, food and drug regulation strikes me as already overzealous here; the 180 degree opposite of wrong is not always right) as well as draconian treatment eligibility crackdowns, which to your credit you don’t recommend but which seem to me fairly likely results of a broad shift toward this kind of approach. I don’t even think you’re wrong. I just worry about it.
Well, I do think that prevention is one of the best strategies (one if the cheapest, as well, long term). I’m not sure what you find overly zealous about food regulations in Germany and think that the health of the German population would also benefit of higher taxes on sugar and lower ones on vegetables. Also healthy and cheap meals in school canteens as well as public canteens offering meals at a reasonable price might be a way to go. Generally, improving living conditions and wealth of the people on the lower end of the spectrum (maybe through raise of minimum wage) has an impact on improving their long term health along with it.
on food, the US is a weird mix of over- and under-regulation (remember that funny article about the bucatini shortage that turned out to come down to regulators obsessing over the precise composition of an imported pasta recipe? but also, having lived in both US and EU and eaten ad lib there with sharply differentiable n=1 outcomes, i suspect there really are a few odd ~toxic ingredients and practices in the US that demonstrably could just be eliminated with a different policy apparatus. do i trust anyone to fix it? no lol but still)
on drugs, US is most definitely over-regulated, but at least you can order baby aspirin on the effing internet there. like. you don’t even know.
This feels like trying to solve school shootings by making everyone a good person who would never kill anyone else, as opposed to realistic solutions like security guards or gun control. It's obviously the right solution, but nobody knows how to do it and we shouldn't let it hold back things that might actually work.
"Make everyone eat healthy and exercise" isn't a solution so much as a fantasy. The government (and other sectors of society) have been trying really hard to do that for decades, and if it was possible to succeed I would have expected to see it by now.
Security guards and gun control are effective measures to prevent school shootings, but so are structures that assure low-threshold contacts for students with troubles with their family or with bullying and while the first might be necessary, the second addresses the problem at an earlier level. On a similar side „making everyone eat healthy and exercise“ doesn’t work if we try to force people to do stuff without changing existing structures. People who have to struggle for their existence tend to chose the path of least resistance, so if the path if least resistance is fast food and cans, they will chose that. However, if we create a path if least resistance that allows people to be healthier on the side, it’s not like they will object. You can improve people‘s health by how you design cities, by making it easy to access structures of every day life (stores, schools, work) on foot or by bike. In Europe there’s another good example in the field of organ donation. In Austria your organs can be used after your brain death by default, unless you disagree, whereas in Germany you have to actively declare that they can be used. Obviously more people are organ donors in Austria, because to actively disagree, you have to mentally engage with the topic and that’s uncomfortable, so not disagreeing is the path of least resistance.
As someone who started looking into thuisbankier reading Mathews’ article and was then beset by akrasia, I want to give this another go. Does Waitlist Zero have counterparts in Europe (specifically the Netherlands)? Their contact form asks for a US address.
Wow, amazed at the quality of writing here. that one blew me away. i had no idea, but have known many in my life who both donated and received kidneys... and i think i knew one whose left one was stolen. But as a non-Dr, and with a RN Nurse sister, I can say this for others, "We don't trust u." Flat out. No trust. Nada. Not for giving blood anymore and not for anything while alive. Sure, harvest everything you can once I am brain-dead, but stay the F away from me until then. Yes, it's that bad. I've been here almost 70 years, and seen shit I still can't believe happen in field hospitals to the best America the world can offer. And now ya got your AI to cut with, so I'm out just from that point alone. You should be really aware about what goes on in the medical-device industrial-complex before you let one of those things tear into ya. FDA? ha. They have better inspections here in Nepal, even with our ragtag group of clipboards and ink stamps. Hate to break ur bubble, but great writing, nonetheless!
Not really, I don't care to discuss, and I didn't bring this up, the author did, but since I am always complaining about people not talking to each other, let me try communicate my truth online again. (This is not gunna go well folks.) Gamereg, I DID say WHY: TRUST. Simple human fear, based on experiences. That's it. And very little reassurances coming from the medical community (in the west) to belay that fear.
However, first responders, top notch. Nurses and medical techs, brilliant. Old school Dr. from an old school university, well, there we begin to have issues. Private MD strapped for cash, or worried about bottom line, more problems. Corporate greed in the Insurance-Medical Industrial Complex, even bigger problems. Keep going up the money chain, and it gets progressively worse by the time you get to Wall Street.
Some might say the above is not a logical reasons to NOT donate blood or kidneys. Yet some just say FU to that. And then many are just wary, confused or ill-informed when entering those big gaping hospital doors. I would think it would be the medical community's responsibility to ease those fears and distrust, somehow. I'd give them a failing F grade in that regard, after the Covid fiasco. And after the Aids fiasco, and all the fiascos between those two black swan events. Hell, throw in earthquake responses I've been part of, and throw in WAR as well, as it's hell and I know no medic can be held responsible for that, but bloody hell, triage in a war zone is not FDA approved. But WAR is approved, so there is that.
That's a long answer for someone I don't know and was never properly introduced to; I guess it's the same at your end. I hope you know me a bit better now, and for whatever reason you chose to reply above, thank you for that and I hope this answers your query.
> No matter how contrarian you pretend to be, deep down it’s hard to make your emotions track what you know is right and not what the rest of the world is telling you.
This sounds to me like it was written by someone with an very different internal experience than me.
Do you actually feel like you “know what’s right”?
My experience is I often have conflicting notions of what is or isn’t right, and “the rest of the world” isn’t telling me one thing or another - it’s a confusing mass of shouting from different groups of loud, confident, intelligent sounding people all explaining why the other groups are stupid and evil.
Sometimes, I’ll see someone do a thing, or be a certain way, and think, wow, that seems right and good and noble, and I want to imitate that way of being. But to me this is like a non deterministic Turing machine that cannot find the truth (it takes too long!) but is sometimes capaable of recognizing specific instances of it.
- what do you mean by not right? Not right for you, like you don’t want to? Not right for anyone? But what does that feel like?
- what do you mean by “rest of the world”? Are you imagining some aggregate function over the emotions of some set of people? Which aggregate function - something like mean or sum? And which people? Anyone alive today? Adults?
I get the impression that lots of people use the same kind of language you are using, but these claims don’t map to my experience, because “it is wrong” for me is a thought that usually translates it to emotion like anger or contempt towards a thought of a person doing that thing.
The notion of “the rest of the world” used to make sense to me as a concept into i tried looking directly at the concept in a way that tried to add some modicum of precision, and the concept itself just collapsed.
I guess it feels, or looks, like watching someone make a mistake.
Definitely no anger or contempt - I suspect this is coming from thinking of a very specific kind of wrongness.
When you see someone not standing up for himself, that is clearly wrong, but it seems more likely to trigger sadness and frustration. That's more the type of wrongness I meant.
By "rest of the world" I meant what most people alive in the world would think.
If you want to save multiple lives and not discover that falling GFR in older age is twice as bad with one kidney (it is, obviously!), donate blood and get on the bone marrow database. You really can make a huge difference. I'm alive today because a delightful young man in Germany gave me some bone marrow stem cells. Yes, that makes me biased, but it's a no-brainer! I used to be a blood donor back in the UK, but here in Canada they didn't want my blood as I'd lived in the UK in the early 1980s - risk of mad cow disease. Moo! They wouldn't take it anyway, now, having leukemia.
I'm also banned from blood donation because of Ireland in the early 2000s and mad cow disease. Somehow never came up with the organ donation. Good luck with the leukemia.
I lived in the UK in the early 1980s and was banned from blood donation, but they recently (earlier in 2023) relaxed this restriction in the US. I'm still in the debating-long-and-hard stage for kidney donation, but I'm signed up to give blood for the first time tomorrow.
Quick update, I went to the blood donor center, made sure to tell them I'd lived in the UK, and finally gave blood! I'm not 100% sure what applies to 1980s UK applies to 2000s Ireland, but I imagine it's similar. With the exception of my vein being pricked with a needle, the process was completely painless.
> (obviously saints can do good things without needing psychological permission first, but not everyone has to be in that category, and I found it easier to get the psychological permission than to self-modify into a saint.)
“Assume a virtue, if you have it not.
That monster, custom, who all sense doth eat,
Of habits devil, is angel yet in this,
That to the use of actions fair and good
He likewise gives a frock or livery
That aptly is put on. Refrain tonight,
And that shall lend a kind of easiness
To the next abstinence; the next more easy;
For use almost can change the stamp of nature.”
― Hamlet, William Shakespeare
Having said that, there's one thing that the article never went into that you'd kind of think would be front and center in any talk about transplants: rejection and management thereof. If you give someone a new kidney but at the same time condemn them to a lifetime of immunocompromise, how much have you really improved their quality of life? The more you look at transplants, the more they look like a really terrible thing that we only do because it's the least-bad option available at the moment, the kind of thing that Dr. McCoy would scoff at and accuse us of being barbarians living in the Dark Ages for practicing.
Out of curiosity, (I genuinely don't know and would be interested in finding out if anyone's looked at this,) has there been any research done on questions along the lines of "would it be more effective to donate a kidney and help one recipient, but we know it works, or to fund stem cell research into own-organ cloning which could end up solving the problem for everyone but is currently hypothetical?"
1. Everyone knows we need a systemic solution, and everyone knows what that solution will eventually have to be: financial compensation for kidney donors.
Over the longer term, I'm highly optimistic about bioengineered human-compatible kidneys grown in pigs.
2. I was getting worried when Scott didn't post much over the last few weeks. Now I know why! And it's a very commendable reason. Thank you Scott for donating!
Personally, I've donated blood and sperm (and I'm due for another blood donation next week). I thought about kidney donation but decided it would take too much time away from my research, and I'm worried about its negative effects on me.
For what it's worth, I know two people who have recently gone through the process. One dropped out late in the process, and the other successfully donated their kidney. This is in the last ~6 months.
The one that dropped out felt very pressured by friends and family, and realized they were not in a good life place to take the time off of work. I think they were scared as well.
The one who donated seemed to have a fine time and was back at work well before expected.
Both reported that a charity was going to pay their expenses, including lost wages. For the one that went through with it, that seems to have worked exactly as advertised.
Kind of related. I’ve always thought that “opt-out” (instead of opt-in) organ donation on driver’s licenses for example, would help increase the supply of organs including kidneys. But when I’ve talked to healthcare economists about it, they say it’s a bad idea because it would bankrupt the health care system given the high cost of these surgeries and the aftercare. Thoughts?
That objection doesn't make sense to me - each kidney donation saves money over the counterfactual dialysis alternative.
I have heard healthcare economists say opt-out doesn't seem to help much in practice because most cadaveric organ donations involve careful negotiation with the family of motorcycle crash victims with the specific box they check being only one input into the family's (and legal system's) decision making process. I don't understand the details here well enough to overcome my common-sense confusion about this not being a bigger deal.
Obviously the castle people could have found cheaper, drabber options, and guests would've been fine with it. I doubt there's a warehouse shortage. It seems EA folks haven't learned much from FTX.
"Hi Senator. Please attend our conference. You'll have to sleep in a bunk bed with the President of Belgium, and there's only one bathroom for fifty people, but please come anyway, it's the right thing to do." Sure, that'll go over well.
More relevantly, you can't accuse EA of not learning anything from FTX because this happened before FTX.
There are decent hotels near industrial areas. Moreover, if I had a lot of money, I would be impressed by the sheer rationality of a simple and cheap meeting room near an area with unassuming hotels (of course taking into account safety, convenience, etc.).
My accusation was not at the castle-dwellers, but at the fact that someone like you can't see how bad and ostentatious a castle looks for the EA movement. A pinnacle of public FTX disgust was the contradiction between the video of SBF signaling his EA bona fides by showing off the meager car he drives while later revelations showed his ostentatious mansion.
Though, since you bring them up, if they are still residing at the castle and not realizing how bad that looks, then my criticism expands.
"Though, since you bring them up, if they are still residing at the castle and not realizing how bad that looks, then my criticism expands."
Continuing to use a castle they own is not the same as buying a castle. If they sell the castle now, people will continue to point to that time and EA organization bought a castle, only now they will cite the fact that the castle was sold as proof that the arguments for buying the castle were bullshit. At the same time, they would presumably lose money on the sale.
It's hyper-rational to admit a mistake and align with long-term goals, even if there are short-term costs.
If the way they differentiate themselves to investors is hyper-rationality, then they can signal that by saying, "We over-rationalized a childish indulgence but we have aligned our investments more rationally and instituted new processes to avoid similar mistakes."
By God, there's a lot of taxpayers in a lot of countries who wouldn't mind seeing the President of Belgium and a senator or similar from our proud nation having to bunk in together.
Anyway - welcome, player, to the multiplayer strategy RPG "Doing Good? or Doing Great!", hereafter referred to as DGDG.
You start off as a starry-eyed idealist of high education and socio-economic class, stuffed with unearned privilege which you are eager to transmute into benefitting the lower types less fortunate than you. Along the way, the choices you make will affect your progress towards one of the two endings:
(1) Doing Good? (for others)
Ultimate Achievement Level: Poor But Honest 😇
(2) Doing Great! (for yourself)
Ultimate Achievement Level: Swankin' Wid Da Big Boyz 🤑
Your progress is measured by your repute (not to be confused with compute, but still important even if it doesn't have a sexy new word) level, on the scale of OPTICS. The higher your repute level, the more you can get away with - but be careful! It is possible to gain NEGATIVE, as well as POSITIVE, repute from the decisions you make, the actions you take, and the consequences of your choices.
Okay, I see you have already completed Act I.
Final Level Achievements:
(1) The Peacock (badge awarded for ostentatious display such as purchase of large, expensive, historic manor house in an agreeable setting in the English near-countryside)
(2) Name Change (reducing confusion or increasing it? both? that's the beauty of it!)
(3) Changing Horses In Mid-Stream (when you pivot from doing what your original aims were said to be, to something completely different)
Congratulations, player, you have now unlocked Act 2 - INSTITUTIONAL BLOAT!
Optics Bar reading:
You have advanced three notches towards À LA LANTERNE. (Warning: if you reach this limit on the Optics Bar, you will be permanently locked out of ending "Doing Good?")
Unlocking this new act enables you to take on side-quests such as:
(A) They Flew To Bruges
(B) Because I'm Worth It
(C) We Always Travel First Class At This Level
(D) The Poor You Will Have With You Always, That's Why I'm Bored Of Them
(E) But We Have To Make A Reservation For Le Manoir aux Quat'Saisons Restaurant, The President of Belgium Expects It
(F) Who Will Roast My Langoustines? (related to side quest E above):
There's an implicit Peter Singer argument in here somewhere. I only have one kidney to give, so by giving it to a stranger, I can no longer give it to a family member.
That's why there's the condition that you donating puts you and 5 family members right at the top of the organ donor list. Plus, you may not be a match for family members, so being at the top of a larger list may actually be a better outcome than saving yours just in case.
Can you try getting the statistics for Israel to get a better idea of the risks? My understanding is that in Israel the situation is reversed, with ~90% of kidney donations being altruistic (unrelated to the patient) so the statistics will be a lot less messy.
IIRC, Israel changed their policy a number of years ago, because there was a lot of religious resistance. The new rule was that in the event of two people needing teh same organ, the one who was previously an organ donor received it. Rates of organ donors skyrocketed.
In Germany it is actually illegal to donate a kidney to a stranger while you're alive. (You can do it when you're dead, but obviously then your kidney won't be as good.) While you're alive, unless the recipient is a relative or at least something like your fiancee, apparently the law considers the dastardly danger of the ever-menacing terrible organ trade mafia too great to allow you to save the DALYs of a fellow human.
> Das Spenden eines Organs, das sich nicht wieder bilden kann, ist zu Lebzeiten für Verwandte ersten oder zweiten Grades, Ehegatten, eingetragene Lebenspartner, Verlobte oder Personen, die dem Spender in persönlicher Verbundenheit nahe stehen, möglich.
And this article² makes a statement to allow for altruistic donations, so it seems like Daniel Böttger is unfortunately right.
For a moment, I thought that the "special personal relationship" permissive rule could be bent ... - but it definitely rules out any case where you don't know the person you donate to at all, as well as anonymous donation.
Here's hoping someone will listen to these doctors' public statements (I found sth similar published by the Federal Ministry of Health (BMG) in October 2021).
Eff tax breaks, why not help the people that need it more? Organ donation for get out of jail cards. Not for murder and rape. But surely we can find it out heart to forgive those people who downloaded a bunch of songs on Napster or something. Next time someone wants to make an argument about how they made a terrible error in judgement and learned from it, there is a way to directly demonstrate that. Hell, kidneys for green cards might just be the kind of proposal both sides might just accept.
I'll grant that 30mS increases risk by 1/660, but that's not the same thing as a 1/660 risk of dying. If your risk of dying of cancer is, say 1% baseline, increasing that by 1/660 is like an extra 1/66000 chance of dying (ballparking here). Am I missing something here?
I mean absolute risk; it literally causes a 1/660 chance of death. That increases your relative chance of death by . . . some amount, depending on what it was before, I haven't calculated that.
explicitly lists the 5% figure as a relative risk which, by my calculations, corresponds to a 1/4650 absolute risk. By all means let me know if that's a bad source, but IMO the math just doesn't make sense if you interpret it as absolute. Google says there are 80 million CT scans per year in the US. If 1/660 of those wound up with cancer then CT scans alone would account for ~10% of all cancer in the country. That's like 1/4 of the total from smoking. There's just no way.
There's also the issue that you're comparing the radiation risk directly to the surgical risk without taking into account that death from cancer would happen many years into the future while death from surgery would be immediate. You'd have to convert both into QALYs lost in which case the risk from surgery would be clearly higher.
The problem with calculating multiplying the number of CT scans with the risk is that a very large number of them are performed on old people or otherwise people whose life expectancy is too low for them to be able to develop a cancer attributable to it.
Wouldn't it make sense for total organ donation to be the default execution method? Lesser criminals could donate a kidney in exchange for reduced sentence.
Elaborate? There's already more than enough prisoners for kidney demand to be saturated, and I'm not sure how individuals who need other organs would be able to increase executions enough to significantly increase their own chance of getting an organ.
I guess if you're against executions even of prisoners in a way that's net life-saving. I wish I had such a positive view of the world that something like that is what counts as "Really really really bad perverse incentives".
I know this is beside the point of the article, but since you're an MD in the field I was curious about your use of the word "schizophrenic" in this article. It seemed like you were using it to refer to multiple personality disorder, which I thought was distinct. I've been pedantically, obnoxiously, correcting this in other writing and ask not questioning if I've been wrong all this time!
You're right that they're distinct; I believe Scott was using "schizophrenic" here to mean generally disordered/without logical flow, which is characteristic of schizophrenic speech.
The blood donation centers assert that donating a pint of blood saves three lives; this seems... overstated... though as brazen propaganda it certainly worked on me. Do you have a more plausible estimate?
Back in the 1980s Evanston Hospital pulled one on me that would probably be considered unethical these days: while I was donating the nurse let a little girl hug me, sobbing, and thank me for saving her mother's life. This is no fair... It did, of course, work; I've been donating at least quarterly since.
Ah, the narrative presented was that her mother had bled heavily that morning while giving birth to this girl's little brother, and that without us - donors - she would have died. She seemed to believe that *my* blood was going to save her mother's life, but that was misdirection on the hospital's part, I think.
"I asked if they could do the kidney scan with an MRI (non-radioactive) instead of a CT."
Radioactivity and ionizing radiation are related but not identical concepts. Radioactivity is a type of ionizing radiation, but ionizing radiation can be generated in other ways besides radioactivity.
CT scans don't use radioactivity but do use ionizing radiation. Nuclear medicine tests use radioactivity. MRI uses neither.
Hey Scott, have you looked at New Zealand's reform?
NZ Initiative, a sort of free market-y think tank advocated for a model where donors are compensated for lost wages (previously donors were only compensated for a small fraction of their prior earnings).
It inspired the Compensation for Live Organ Donors Act, which states "live organ donors who are eligible will be paid regular weekly earnings from the day of their surgery and for up to 12 weeks while they are recovering."
Thanks! In the US some donors can also be compensated for missed wages while they recover, as of 2017. I don't think this has helped too much, although it might be too early to tell.
Coincidentally enough, in today's NYT crossword puzzle, the clue for 10 Down was "Givers of priceless gifts", and the answer was "ORGANDONORS". Well done, Scott!
I've seen discrepancies before - it seems we get the NYT puzzles (in our local daily paper) some time after they first appear. (Canadian prairies, for what it's worth.)
Oh yeah. I know what you mean. I used to work them on a physical newspaper in the before times. I'd get them in the Saint Paul Pioneer Press (Saint Paul, MN is in southern Canada ;-) )
In that paper they were running about 6 weeks behind the NYTs!
No doubt it is a relief. I live about a mile south of Summit Avenue. Just where the long uphill from the Mississippi begins to level and descend to the Capitol. I usually cheer the runners on from that point. But this year the marathon was cancelled due to the temperature being much too high. :(
Summit Avenue, if I am remembering correctly, is aptly named. I belive the long climb starts around Mile 19, and continues to c. Mile 25.5.
I had been told to watch for the glorious sight of the golden dome of the Capitol, and that the run was downhill from there. As it turned out, there's a false summit partway up, complete with the shiny dome of a church.
Nevertheless, it was a tremendous experience.
*****
Somewhat even farther off topic, how is life in the Twin Cities these days? We non-residents have heard horrid stories of rampant crime, mostly coinciding with the George Floyd riots and COVID. I hope things are not as bad as the media would make them out to be.
Beautiful entry Scott. I donated for a selfish reason (to a family member, my dad) but still share most of the sentiment (and post-op hiccups!). It really resonated in me. Congratulations and my best and sincere wishes to you.
I asked the plasma donation place when I was planning on donating, there's temporary deferral in the immediate aftermath (it is a surgery, after all), but nothing long term.
Does anyone know if there is an equivalent to the thing about giving 5 family members names for priority kidney donations when you live in the UK? I may have missed it somewhere but I can't seem to see it on the information online, and you'd think it would be something they'd make very visible if it was an option.
My kidney mentor was very helpful because she told me to set up my voicemail. I think I would have disappeared into the kidney abyss if I hadn't done that.
Also, sometimes you really remember the salary differences in EA - even if I took a full four unpaid weeks off (currently planning on two, probably paid, weeks) - I would not get close to losing $5000.
Can't answer for Scott, but I never set up mine. There's a risk that people will start leaving me voicemails! And worse. They might expect me to listen to them!
Because I also didn't believe it, I looked into it. The 1/660 number seems OOM correct.
From Radiation Dose Associated With Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer by Rebecca Smith-Bindman, et al, they estimate you would require 498 40yo male patients receiving a multiphase abdomen-pelvis CT to give one of them radiation-induced cancer. While this radiation-induced cancer is not necessarily mortal, it is probably >10% lethal (some of the other looking into it I did suggests ~50%), so that number sounds right-ish.
you really are a saint! (I lost my paternal grandfather early to kidney failure, my father is on dialysis and my uncle was too for years until his wife donated him her kidney. both me and my sister also have slowly failing kidneys so I know how valuable a functional kidney is) I hope if there is an afterlife you go to the best section of it.
by the way here in the netherlands what worked great was to make being an organ donor the default option rather than not being an organ donor. turns out the vast majority is just too lazy to change the status.
As a male your lifetime risk of developing cancer is around one in two. A 1/220 additional risk modifies this to become 0.5045. So the difference is fairly miniscule. The 1/10,000 risk of death from the operation is a probability and so is not comparable to the excess risk value.
I don't understand why a 1/10,000 risk of death and a 1/660 chance of death aren't comparable.
(they're not perfectly interchangable because one is per operation, ie a specific day, and the other is per lifetime and has to be discounted for a death at age 80 not being much worse than what you'd get otherwise, but besides that I don't understand).
I also don't think that comparing it to lifetime risk of cancer anyway is useful context. Which would you prefer: a 1% absolute risk increase of dying from cancer, or a 1% absolute risk increase of getting eaten by a giant squid? The 1% cancer represents a 2% relative risk increase, and the 1% squid represents a 999999999x risk increase, but they seem about equally bad to me - I've got an extra 1% absolute mortality risk either way.
Yes but I suppose what you measured doesn't depend on what I prefer.
I am assuming that the 1/220 risk is distributed over the entire lifetime. I think what you're assuming is that it measures the risk of developing cancer immediately after the scan, rather like the risk of dying due to the operation. I don't know for sure which view is correct, but I think my interpretation is the right one.
"I am assuming that the 1/220 risk is distributed over the entire lifetime." If it is distributed evenly over a lifespan (as a very, very, rough approximation), I think that comes out to half the QALYs lost that an instantaneous 1/220 risk would cause. To put it another way, the mean effect of a 1/220 risk, spread across one's remaining lifespan is (I think, if I have the math right) equivalent to an instantaneous 1/220 risk halfway through one's remaining lifespan.
Your methodology for calculating the risk from the radiation dose received in the screening exam is flawed. The thumbrule you quote is correct, but the risk from radiation exposure is not linear. Low doses are much less problematic than large ones, as the body has the ability to repair radiation damage up to a certain threshold.
Good for you for saving a life! According to the Talmud, you’ve saved an entire world! Why didn’t you meet with the kidney recipient though?
Modifying NOTA is brilliant and necessary. Reducing taxes for ten years seems like it only would incentivize middle class and rich people who pay taxes. This would cut out 50% of the potential donor pool. Why not just let Medicare pay donors; they’d still be saving money by not having to pay for dialysis treatment. I wrote about this years ago.
it would be a refundable tax credit, so if your taxes are less than the credit, you get a tax refund check for the difference. this may not be the ideal way to administer it but it would probably work fine; lots of low-income people already file taxes to get the EITC which works like this.
Ok, I can see that as an argument for not meeting the recipient. But I know several organ donors who met their recipients and it was an amazing experience for all involved parties.
Wow, Scott! That's a wonderful thing you just did. It shall be accounted to you as righteousness!
Like many other commenters, I was speculating that maybe your wife just had a baby and that you were going to pop back in here with a "Hi everyone, meet Earendil Metatron Alexander!" I did not see a kidney donation coming.
Excellent, excellent, excellent. As an applied use of mild recurrent OCD and a comprehensive examination of voluntary kidney donation. Thanks for both.
Congrats on donating! I've bought specially branded t-shirts that say "I donated a kidney to a stranger and all I got was a stupid t-shirt" for people who have done that. I don't know if you're going to read comment #310, but let me know if you want one. From the people who have one, it's apparently a cross between funny and helpful to start conversations
The amount of bureaucratic friction placed between potential donor and donation sounds wildly disproportionate relative to risk, need, and reward. Sorry you had to go through that. Maybe just reforming the bureaucracy, with good rather than bad bioethics norms, will go along way toward pulling that % of donors up to 1-3%.
I think because it's adjacent to a lot of bad ideas and sets off people's "bad idea detector" in a way that doesn't turn out to be valid once you think it through.
Like if risky performance-enhancing drugs are legalized, then in competitive fields, taking on the risks of the drugs will be table stakes. Or, "if lots of people have an extra $10k a year in income, won't that just raise rents by $833 a month, to the point that people can only afford to live in San Francisco if they donate a kidney?". Or, "Won't this only appeal to desperately poor people, so we're using the poor as organ farmers?". They basically all boil down to "you don't want the compensation for donating an organ to become something that people depend on".
But there just aren't *that* many people on the waiting list in the grand scheme of things, so there'll likely never be enough kidney donor slots for it to become the sort of thing people do to just get by.
You'd almost want to scale the incentive based on number of willing donors versus remaining demand, which makes me realize I'm talking myself into a market for donated organs.
If you don't want people to make desperate decisions for money, the proper patch isn't banning specific forms of that, it's categorically eliminating poverty via Georgist LVT and UBI.
An under-regulated market for organs and tissues would have horrific risks due to the potential for outright theft, but we seem to have swung too far in the opposite direction. If compensating organ donors is to be permitted at all, how about simply using government fiat to set the price in dollars equal to the number of people currently waiting on a transplant? That sort of variability might help prevent exploitative business models from becoming entrenched, while incentivizing folks who want to get the best cash value for their bodily integrity to lobby for transnational cooperation.
I wonder if part of the unpopularity is that 'stranger donors' tend to be weird (see below, and WEIRD, see Joseph Heinrich), and that most people, if they have any exposure to the concept, is from the emotional torture porn/Will Smith vehicle Seven Pounds. Which isn't altruistic donation (he's doing it for redemption, to balance the scales), but is possibly the closest thing in mass media.
>Your brain uses the same emotional heuristics as everyone else’s.
No, I suspect that's not entirely true, or EA either would not exist or be wildly more popular. See below-
> I asked them what kind of therapy was indicated for mild OCD that’s been in remission for twenty years.
While I want to assume the professional psychiatrist knows more about OCD than I do, I'm... *unconvinced* that some noticeable degree of EA intuition isn't a variety of scrupulous OCD.
That isn't to say it's not real, or that they're not doing good, or there's not similar parallels in many ways, or that "wanting to do good" is a problem, etc etc. Try not to be unnecessarily uncharitable in reading me, okay? But the commonality of the intense empathy, intense desire to do good, generally-somewhat-and-sometimes-*really* radical unselfishness strikes me that indeed *no*, your emotional heuristics are clearly not the same. In some cases you go to lengths to, as you say, [remove those guardrails](https://www.astralcodexten.com/p/book-review-what-we-owe-the-future), but at least to some degree it seems innate.
Edit: My own (pointless, sidelines) take on the Castle Scenario is that buying a venue is not, in theory, a bad idea. That venue in particular clashes with the general "aesthetics-deficient" perception of EA, but more importantly for why it caused such a big stink, communication about it was awful and in the end they just wound up downgrading the EA Forum community section to get over it, which is not a great solution. Sort of a... "trust your betters" and "shut up, peons" vibe; a lot of unforced errors involving the communication and not just the actual purchase.
I think part of the problem is the admission "we had tons of money sloshing around and nothing better to spend it on, now that funding has dried up yeah we probably wouldn't do that again".
If you have so much dosh, are there really no secondary, tertiary, or further down the list charities you could donate to? Not even throw a few bob at the local Home for Blind Three-Legged Puppies?
It's not a good look to be an ostensible charity based on "doing good better" and then do things like this, when there are plenty of "this region has been hit by flood, drought and famine and we really could use some food, medical supplies, and housing aid" campaigns from other charities. Especially since it seems (though I could be getting this wrong) to be the brainchild of one guy who managed to swing the funding for his pet project of "why can't we have big, swishy, luxury centres like the ones I went to in Europe?" and then stepped back out of any commitments to be responsible for running or further funding the place.
The castle incident arguably isn't the most shocking thing about EA.
It is interesting, in a grotesque way, to read people who admit a willingness to kill (or at least watch die, or cripple with malnutrition) a certain number of humans in order to save (or make less discomforted) some larger number of chickens, or shrimp, etc. talking about "doing good better."
My colleague Luke Semrau has written several articles arguing that there should be a kidney market. https://philpeople.org/profiles/luke-semrau. I think his work is good, despite the fact that utilitarianism is a false theory of morality (my main objection to EA enthusiasm).
I wonder what the breakdown of the 100K on the kidney list is between people who had kidney failure through no fault of their own (non-fun sports/stupidity accident, genetic disease, autoimmune) vs. lifestyle choices like diabetes due to eating too many fudge rounds.
Does this factor into the altruism view - of potentially rewarding someone for bad decisions?
People who eat their way into kidney disease are less likely to get approved for a transplant, because they're more likely to continue the self-destructive behavior that got them in trouble in the first place. So whatever the underlying % of "deserving" people with kidney disease is, it's probably higher for approved recipients.
Good job Scott! I ran into logistical issues last time I started this process, but I now feel inspired to give it another go.
On the topic of the “castle” scandal. It’s important to know that there actually were two “castle” scandals, the second one being the ESPR chateau purchase which I made an EA-Forum post about:
This post got a comment from a high-profile EA who was more involved in the project accusing me of spreading falsehoods which he promised he would write out later.
Naturally, since he was a high-profile EA much closer to this purchase and I’m just a random schmuck, a bunch of people heavily down-voted it, I lost karma/voting-power and the issue itself lost visibility and is now largely forgotten.
However, when the person later gave the promised list of falsehoods he put it in a swamped comment section without a link or mention of the original post which would’ve allowed people to compare. If they could’ve done so they would’ve seen that his comment didn’t point out any falsehoods at all and in fact spread a bunch of falsehoods about my post, the most egregious one I consider him vaguely implying I doxxed a bunch of people. (to this day I have trouble getting EA’s to reply to emails or accept my applications, and I have to wonder whether that’s because they think I’m a liar and a doxxer)
To mangle a quotation from a countryman of mine: "To purchase one fancy-schmancy residence, EA, may be a misfortune; to purchase two, looks like carelessness".
This is the kind of thing people worry about with regard to the wider movement devolving into taking in one another's washing. Start off going "let's get a real sense of value for money when it comes to charitable donations instead of warm fuzzies", somehow end up "but we need big fancy stuff because we're just that important".
EVF as now is, or rather this Owen guy, seem to want to develop Wytham Abbey into the likes of Annaghmakerrig or Yaddo; an agreeable rustic retreat where you can mingle with the like-minded and be inspired to be creative. Very nice, but now you guys have become that exact administratively-bloated foundation that is more concerned with doling out the goodies to the very important people with the big titles at the head of the shooting gallery, instead of the original aims of the organisation, that was the very thing the EA movement started out critiquing.
Owen seems to have convinced everyone to fund that manor house purchase mainly because he was really impressed with the big, important places for big, important people that he had visited, and wanted a big, important place of their own to go and be big and important in.
I remain to be convinced this is actually a good idea.
Can you elaborate more on the exact criteria for psychological conditions precluding you from donating your kidney? Clearly it's variable across institutions. Will having a mild mood disorder (which honestly doesn't affect my decision-making at all) on my record be a problem?
I wasn't given any more information than that I was rejected for OCD, but that they might reconsider if I did six months of therapy. I think every hospital has its own criteria.
When I did the screening earlier this year I did have to (maybe I could lie). I was diagnosed after I filled out the form. but I can't donate until next year due to age restrictions. I'm a bit worried it'll be a problem next time.
If you really want to donate, I'd consider going to another transplant center and not mentioning it. Not sure, but I doubt that one transplant center would communicate confidential patient data to another.
I am incredibly proud of you Scott, incredibly proud. I have been reading your blog ever since I was about 16, pretty much grew up on them and I am also a transplant recipient. I have to say, there has never been such a step change in my state of existence. Going in to the operating room I felt terrible, I then went under sweet anesthesia. When I woke up, I felt better, much better! I had just undergone a serious surgery and I was feeling better! The nurses wheeled me in to my mothers room. My mother, the visage of the Madonna was laying in her bed, having given birth to me a 2nd time. They held up the bag of golden urine, the water and waste trapped within me was gushing out. What happened in that operating room felt like a magical ritual. I am incredibly grateful for you that you helped someone experience what I experienced.
As for my story, I had kidney failure 1 year ago. I was on peritoneal dialysis (not hemo, where blood is taken out of the body, this is the usual one in the hospitals). To illustrate what this is like. There is a catheter attached to your abdomen. This catheter goes in through your abdominal wall, creating an open, oozing wound. I had huge psychological troubles with the catheter. It essentially made me feel disgusted with myself. I would carry it around attached to an elastic belt. Every breath I would take would lead to me noticing the catheter, noticing my disease. Noticing that I was a failed organism that had lost its ability to get rid of its waste.
The other end was connected to the dialysis machine, essentially a big pump. Every night you set up the machine at home. This involves connected about 10l of dialysis solution to the pump. During the night it pumps about 2l in to your abdomen every 1.5 hours or so and pumps it out. The waste in your blood diffuses in to the dialysate contained within your peritoneal cavity. This is then pumped out by the machine.
Sometimes, I would wake up with about 3-4l in my abdomen, belly bulging, the skin taut like a drum. The machine constantly kept me awake so there wasn't too much sleep anyway. It honestly was a limbo like experience waiting for my transplant. And despite all of this the dialysis only gets you about 5% of kidney filtration. That is it. You still suffer daily from nausea and fatigue. Not to mention the fluid restrictions, these were the worst.
Have you ever went 2 days without drinking any fluid? No water, no tea, no coke, nothing. Absolutely nothing. That was my existence. I had to double think about whether to eat a certain food if it had too much water. When you can't urinate, there is no where for the water to go. I also noticed how much of our social life revolved around drinking things.
So I tried to take power in some shape or form in to my own hands. Even after a transplant the future of the transplanted kidney is not certain. The prospect of returning back to dialysis haunts me, like the Sword of Damocles it hangs above, ever present. I want to vanquish this specter, I felt like I was robbed of a normal life by disease, so it was time to fight back. I have a mechanical engineering PhD, I was in automotive. I applied to all the Nephrology groups I could think of, for anything. I wanted to learn, I would do any technical thing for them in return for knowledge and experience in the field only. I did not want payment.
In the end, I had two offers. One was an internship at Erasmus Medical Centre on kidney Organoids. I believe that the eventual solution to the problem rests with lab grown organs. The other offer was from University Medical Centre in Utrecht. This was a 3 year post-doc position on developing an implantable bio-artificial kidney. I was in a dilemma for a while. I wanted a final solution and only the fully lab grown organ was that. But the future to that is uncertain. What if we really need the full embryological niche to build functional tissue? There are so many unknowns.
One night, I was walking back from my girlfriends house (15 minutes down the road walking) to my rental, to my machine. I was feeling horrible, the dialysis can't manage electrolytes very well, so sometimes I felt like my muscles weren't entirely there. Having left her house, without being able to sleep in the same bed (though she often came overnight to me, bless her). I finally resolved to start working. Not fundamental research, but hard engineering work which may yield an imperfect, but far better than what we have currently have, solution in the medium future. So I accepted Utrecht's offer.
I am still amazed that these guys took the risk, to accept a guy with no prior experience in the field. It really amazes me, I do feel indebted to them to some degree. Having started the project and seen how interdisciplinary one needs to be, I think indeed the most important thing is competence and drive. The former is to be proven, latter I am sure I have. I am writing this from my lab. I am currently setting up testing and device/prototype fabrication pipelines. I came in to lab 3 weeks after my transplant surgery which happened 30 May 2023. Its a huge project, and its requires all my efforts. But in the end, I will need more hands and minds.
There are parallel efforts happening in UCSF (your favorite place Scott!). But I have doubts that I shouldn't raise publicly under my own name. In any case Scott, if you want a chat about the project I would be honored (I could also tell you something about the transplant process from the transplantee side, my experience here was quiet interesting and similar in nature to yours!). In the end, for us publicity will be helpful. But more importantly, hands and minds.
I am 28. I hopefully have a long life ahead of me, and unfortunately, a lot of time to go back on dialysis again. The last thing I want is to hold my child with a catheter attached to me. Never again.
Good work! I have a vague memory of Dylan saying he thoughts about a dozen people had donated because of that article, but I'm hearing from enough people that I'm starting to suspect it must be more.
My husband has a rare genetic disorder that caused kidney failure in his 30s, and is currently on dialysis. We have a donor in the pipeline but no guarantees of anything, ever.
I would like to be an advocate for increasing the number of kidney transplants and was interested in the proposal to modify NOTA. Having "opt out" rather than "opt in" organ donation on driver's licenses and other IDs would also increase the number of deceased donor kidneys available.
I would appreciate connecting with your kidney mentor or anyone else interested in a coordinated effort to promote kidney donations.
You can click on Join The Coalition at https://www.modifynota.org/ and someone will get in touch with you by email.
(I think I heard that switching from opt-in to opt-out doesn't work as well as expected, but this is after five minutes of research, so if you know more, please let me know)
"Everything else I try to do, there’s a little voice inside of me which says “Maybe the haters are right, maybe you’re stupid, maybe you’re just doing the easy things. Maybe you’re no good after all, maybe you’ll never be able to figure any of this out. Maybe you should just give up.”"
This sentiment makes me want to scream. You’ve written things for years that many people have enjoyed, have found interesting enough to take into their own vocabularies and mental models and cite and link to years later. There are multiple thriving communities out there that are offshoots of your blog’s comment section. That you can’t trust the value of your own work - work that may be easy for you! but has not been done by anyone else! - because it can’t be measured in QALYs or DALYs or whatever is... frustrating, sad, and not surprising of course to anyone who’s been reading you for some time.
But letting the social circle and not-a-religion inside your head win is worse in some ways than the Guardian columnist, because you know the columnist isn’t you.
Very interesting story and analysis. One question my wife (coincidentally a Weill Cornell doctor) wondered: Is there an EA movement towards encouraging people to donate blood? That seems comparatively simple and costless, and there's a shortage right now.
I think it's not a very loud movement, but it's something that everyone agrees you should do.
Ironically, I can't donate blood myself because I lived in Ireland for a year when they had mad cow disease, and there's some ancient rule banning anyone in that category from ever donating blood. For some reason this doesn't apply to organ donations. I can't explain how or why any of these rules work, and I might be totally misunderstanding them, but I was rejected last time I tried.
It seems like it's possible to change those rules, in Germany they are now allowing men who have sex with men. Perhaps with UK/Ireland mad cow possibility exclusion no one really bothered checking if that rule still makes sense or is useful.
As mentioned below, that has been recently changed. The rationale, according to the Red Cross website, is this (tl; dr - they thought variant CJD - mad cow disease - could develop into CJD proper, there isn't a way to test for this in blood and it can be passed on via blood transfusion):
"In-Depth Discussion of Creutzfeld-Jakob Disease (CJD) and Blood Donation
CJD is a rare, progressive and fatal brain disorder that occurs in all parts of the world and has been known about for decades. CJD is different from variant CJD, the disease in humans thought to be associated with Mad Cow disease in the United Kingdom and elsewhere. There is no longer a deferral for travel, residence or transfusion in the United Kingdom, Ireland, and France from 1980 to present, which was previously considered a geographic risk of possible exposure to vCJD. Individuals who have been previously deferred for travel, residence or transfusion in the United Kingdom, Ireland and France can initiate donor reinstatement by contacting the Red Cross Donor and Client Support Center at 1-866-236-3276. Individuals with questions about their donation eligibility can contact the Red Cross Donor and Client Support Center at 1-866-236-3276.
CJD appears to be an infectious disease. It has been transmitted from infected humans to patients through the transplantation of the covering of the brain (dura mater), use of contaminated brain electrodes, and injection of growth hormones derived from human pituitary glands. Rarely, CJD is associated with a hereditary predisposition; that is, it occurs in biologic or “blood” relatives (persons in the same genetic family).
There is evidence that CJD can be transmitted from donors to patients through blood transfusions. There is no test for CJD that could be used to screen blood donors. This means that blood programs must take special precautions to keep CJD out of the blood supply by not taking blood donations from those who might have acquired this infection."
The "intuitive" objection to EA (particularly EA as exemplified in this piece) has teeth.
Donate a kidney to a stranger, and now you haven't one to spare in the event that someone close to you (relative, spouse, child, friend) happens to need one at some future point.
The "off-the-shelf human" intuits that a stranger-donor puts a finite multiplier on the "value" of prolonging the life of a relative/spouse/friend (the probability that this opportunity ever comes about is not pertinent, so long as it is not zero) vs. that of a total stranger. This is not how a "blood is thicker than water" standard-issue human is wired; it "fails checksum", and not everyone who breaks out in hives when reading about it is able to articulate the precise reason why. But it is a healthy reaction nonetheless.
It is part of why EA comes off as a creepy, evil cult to many people, and articles like this do their necessary bit to make it so.
Stalin famously refused to ransom his eldest son, who perished in German captivity. (the offer was to trade field marshal Friedrich Paulus, captured earlier at Stalingrad.) "We do not trade privates for field marshals." Whatever one may think of Stalin -- whether one sees his act as a heroic one, or simply further proof of his depravity -- it was an unusual act, and I find it difficult to imagine that most people would wish to inhabit a society where it would be regarded as ordinary and expected. Perhaps EAs would -- but this is why EAs are creepy, evil cultists from the POV of someone who doesn't also practice that religion.
From my non-EA, "normie" POV, to be willing to sacrifice your spouse, child, sibling, parent in order to save ANY number of total strangers, is a depraved thing. And the people who break out in hives when thinking about it, do so for perfectly healthy, valid reasons. And I break out in hives with them, when contemplating a society where people do in fact regard their family and friends as fungible vis-a-vis strangers, regardless of how numerous or imperiled the latter may be.
"For God so loved the World, that he gave his only begotten Son"... Regardless of whether you personally are a Christian, I feel that quote (and how it resonates with billions) suggests that many people consider it the noblest of sacrifices.
> "Donate a kidney to a stranger, and now you haven't one to spare in the event that someone close to you (relative, spouse, child, friend) happens to need one at some future point."
As I mentioned in the post, the kidney bank understands this objection, and in exchange for your nondirected donation, they give you a free credit you can spend on a kidney for a friend or relative in the future.
(although I'm suspicious that the kind of people who make too big a deal of this objection aren't the type who would donate to a family member anyway)
You sure are judgmental as hell. And convinced that your spontaneous reactions for and against various things are the standard by the which other people's choices should be judged. Where'd you get the idea you're the gold standard?
I understand why Stalin did that (quite apart from him being a tyrant): it's the same logic as "you don't negotiate with kidnappers". Trading a low-value prisoner for a high-value one during war time harms your war effort. It looks like favoritism - it is favoritism - and engenders resentment amongst the ordinary people whose POW sons aren't the children of high party officials and can't be ransomed the same way. The knock-on effects on morale aren't good.
It's trying to balance out the demands of being a private individual and parent versus those of being a public figure and national leader during war time. If you're President Smith and you take that bargain, people will understand. But they won't trust you in any other decisions, and now your enemy knows you have a weak, soft spot and how to attack it. Next they'll offer to trade Private Ryan for that spy you captured, and how can you refuse? If you accept, you're hurting your own country. If you refuse, there's a ready-made scandal about how you did it for your kid but not for the Widow Ryan's kid.
That's probably why you have the Sole Survivor Act:
God f*cking damn it, I also got rejected for mild OCD by UC Health here in Colorado. They did NOT respect my right to bodily self-determination, and this was after I had done the 24 hr of pee, full day of tests, lots of follow up tests (a weirdly high fasting blood glucose level but fine results in the challenge test, concern over LVH but turns out I'm just a runner, neutropenia but turns out it's congenital and not a problem). I didn't disclose that I had OCD, because I didn't know at the time. Initially, I didn't agree with the diagnosis (scrupulosity - which seems a little too convenient of a diagnosis for someone trying to give away their spare kidney), but as time passed, I realized he had a point. It doesn't matter though. I am confident that my OCD was unlikely to cause much of a problem with donation / recovery. I would have happily given my informed consent, and I resent the hell out of UC Health for not giving me that option. They kept on repeating that because I was in good health, they needed to be diligent about making sure I could stay in good health after the donation. This paternalistic pablum makes my blood boil, though I know physicians take "do no harm" seriously. But I would appreciate if they would widen their view. Being denied the agency to donate my spare kidney did activate my OCD rumination - did they care about *that*? What about the loss of utils - to the recipient, but also potentially others if mine were a bridging donation? Their consequentialism is irritatingly narrow. Sincere, but narrow.
Congrats for not letting the haters get you down, and completing your donation. In your face, UCSF!
I mean, it makes sense to me that someone giving away a kidney to a stranger would be dealing with scrupulosity, and that this is a good reason to not allow the donation.
To me that sounds an awful lot like "we think you care about strangers too much, so we're going to murder a random stranger (prevent you from going out of your way to save them, same difference) just to teach you a lesson."
When actual real-life doctors are taking an ethical stance that comic-book supervillains would flinch away from in horror, something needs to change.
With scrupulosity, the motive isn't caring about strangers too much - in fact, it's not based on caring for others at all. It's based on feeling completely worthless and evil, and needing to do something drastic. This is not a healthy motivation and someone who feels this way shouldn't be allowed to donate, even if it saves a life.
And it's not murder - the recipient is dying of kidney disease. It's not the same at all as murder to make a determination that the potential donor is not of sufficiently sound mind to make the life-changing decision to donate an organ.
If your life were at stake, you might take an organ from someone who wasn't in a good mental state to donate. Or you might not feel comfortable doing that.
Regardless, the recipient isn't exactly a neutral party to properly make that decision.
If the donor and the recipient together can't be trusted to make such a decision, who can, and on what grounds?
In many parts of the US it's circumstantially permissible to shoot a complete stranger with a pistol, or otherwise gravely endanger their life, in order to preserve your own. Their mental state is seldom considered relevant - debate is more often focused on availability of alternatives, "duty to retreat" and so on.
Granted, there's less time pressure involved in kidney transplantation than in violent self-defense, so it makes sense to demand more careful scrutiny... but donating a kidney in a proper hospital is considerably less dangerous than a gunshot wound, greater harm is being prevented, and the closest thing to a viable alternative anyone's found so far is dialysis, which seems to be on a comparable level of nobody-should-be-forced-to-do-that as "retreat from your own home." Why is informed consent from the donor insufficient for what seems like a much clearer win?
Do you have scrupulosity? I see that you've commented about multiple times so you must be familiar with it.
To the psych, scrupulosity was the best-fit OCD diagnosis for me. I am unusually concerned about doing right by others, and sometimes I do feel like a bad person for no particular reason. The latter is pathological, but it doesn't mean that it is the source of all my altruistic impulses. I have a bit heart and a lot of natural empathy. I've cultivated enough mindfulness to see which actions bring me sustained joy - and acts of kindness is a big one. Like many EA/LWers, I try to live the philosophies with which I agree - and I have arrived at these philosophies with care. So while I see that the psych had some accurate observations (and frankly provided me some life-changing self-insight), he reduced all my geeky/aspie/philosophical/empathetic altruistic intent into pathology.
It was incredibly frustrating and even a bit hurtful. There were other problems as well (such as my social worker inappropriately suggesting that I have body dysmorphia, because I was asking questions about how soon I could resume my cardio after the donation).
A much better model would be for the psych to advise - to let me know his thoughts and the risks. Why is my "informed consent" insufficient in this case???
Psychologist here, and OCD specialist. I thought it might be helpful to lay out some info about OCD in general and scrupulosity in particular.
There are a lot of behaviors and patterns of thought that *could* be considered scrupulosity: religious observances; adherence to various regimens of exercise, recycling, charitable donations, whatever; ruminating about ethical issues. The diagnostic bell-ringer is that OCD behaviors are driven by a deep, fear of bad consequences if one does not do them. And the OCD sufferer recognizes that the fears are irrational. Here’s an example: I have a patient who is in fact genuinely religious. When he hears on the news about tragedies he says prayers asking god to help the people involved, and those are real, heartfelt prayers. He also feels compelled to stand before each crucifix in his house and cross himself before he leaves his home or goes to bed, and that is an OCD ritual. He does not experience those rituals as expressions he religious devotion, and in fact says "doing that isn't real religion." He does those rituals because he fears something bad will happen if he does not do them. Mostly he fears the death of family members. On the same occasions he also does a ritual checking of his stove to make sure it's really really really off, and checking the stove feels to him exactly the same as crossing himself -- a precaution against something bad happening. If he skips either of these rituals he feels gnawing anxiety.
Here’s an even more extreme example of the difference between religious scrupulosity and the observances made by genuinely religious people. I had a patient who was an atheist, but avoided saying “lived” because it was “devil” spelled backwards. His fear was that if he said “lived” he would be demonically possessed. He did not believe in demons, either, or in anything else supernatural, but was still subject to powerful, unabating anxiety about demonic possession if he said “lived” or skipped any of his many other rituals (touching and tapping things, repeating actions).
Another diagnostic criterion for OCD is that the rituals, together with fretting about rituals and worrying about the feared bad consequence take up a substantial part of the person’s time and mental energy. People with scrupulosity are preoccupied with their rituals and the bad consequences they fear if their rituals are inadequate. It is at least in the back of their mind all the time, and often in the forefront. They are preoccupied the way somebody on the verge of backruptcy is about bills, creditors, the desperate hunt for a solution, dread of the bankruptcy itself.
So for those wondering whether their ruminations about morality or their commitment to actions they see as ethical are in fact scrupulosity OCD, the 2 criteria above should be helpful: Are you doing these things mainly because you dread some bad consequence, especially one that’s extreme and implausible, if you don’t do them? That weighs in the direction of OCD. And does fretting about the ethics of your actions take up a *lot* of space in your mind? That also suggests OCD. And here’s a third thing to consider if you’re wondering if your ethical concerns are mostly scrupulosity OCD. Have you ever had any other form of OCD? Have you felt compelled to tap things, repeat actions, arrange things a certain way, keep things way cleaner than necessary, neutralize “bad” thoughts with good ones, avoid certain “bad” numbers? If so, that makes it likelier that your preoccupation with ethical issues is OCD. But of course it might not be. Ask yourself whether thinking about ethical matters *feels* like the OCD you’ve experienced.
Thanks for these details. Would it concern you at all if someone with an OCD history donated a kidney to a stranger out of a feeling of guilt or moral obligation? How do you see Scott's situation?
Sounds like your religious patient has a good handle on his scrupulosity, and I hope he sees an improvement there. Thanks for the detailed reply and good luck in your professional endeavours, you seem to be doing good work!
I'm sorry you were labeled and pathologized. That's not right. I really hate comments to the effect of "that's just being aspie" or "I know better than you because you're aspie" - sounds very frustrating.
You had another comment about workplace OCD but it seems gone now - did you delete it?
I'd be concerned about acts of kindness that significantly hurt you, like donating an organ, which I see as an act of self-harm, or needing to make apologies that hurt your position at work.
When you say "after the donation" do you mean you donated a kidney also?
I'd say "informed consent" is not sufficient in a situation where you're trying to treat a problem improperly. If I have the flu and ask a doc to remove a kidney because I think it will help with the flu, even if I give informed consent, should the doctor do it?
Suppose Alice is sinking in a flooded river, while Bob stands on the shore, swinging a rope overhead. Before the rescue can be completed, Eve snatches the rope away from Bob, berates him for publicly indulging his cowboy-cosplay fetish, and insists that he take a six-week lifeguard training course before proceeding. He agrees with the diagnosis and does so. Meanwhile, Alice drowns.
"So you're saying I would have just made the situation worse?" asks Bob.
"No," says Eve, "that lasso trick almost certainly would have worked. I just thought you were doing it for the wrong reasons."
if Eve did that with the intent to kill Alice, then you could argue that, yes. If that wasn't Eve's intent, I don't think you could call that murder.
But more importantly, that situation is not comparable for two reasons.
1. In your scenario, Bob is a rugged individualist perfectly capable of rescuing Alice on his own. But with organ donation, Bob is not singlehandedly removing his own kidney and implanting it in Alice. Rather, Bob is asking medical professionals to use scarce time and resources for this, and further asking for other scarce resources, eg from nonprofits. Bob can't save Alice without the help of the whole network of professionals and the organ donor system. Further, Bob is asking for a special status, the status of being an organ donor, though that's a lesser concern.
None of these things are free, and medical professionals have a duty to make sure their patients are qualified and have informed consent before they start removing organs and start allocating scarce resources.
2. The organ donation example is more like a case where Bob, in fact, can't swim. Or at least a case where there is a good chance that Bob can't swim and will fail to do the rescue or will injure or kill himself.
What I mean by that is that organ donation harms the donor, as Scott points out (but minimizes) in the essay. It has costs on the system in that Bob now has claims on other organs. There's also concerns about regret and psychological harm to Bob, and not treating Bob's actual problem.
So a better analogy is that Alice is drowning, and Eve is a lifeguard trying to rescue hundreds of people. Bob has a lamprey attached to his arm gradually eating him, and erroneously believes that if he rescues Alice, the lamprey will stop, so asks Eve to stop rescuing others and take him to rescue Alice. Eve says "no, I'm busy rescuing others, and let's try to actually treat that lamprey."
This is so interesting — I was a non-directed donor through UC Health in CO less than two years after dealing with some moderate OCD and undergoing about six months of therapy for it. When I had the evaluation at UC Health, I told them about this up front, including the fact that I felt like the therapy worked and I had improved a lot. Eventually, as part of the evaluation, they basically had me sit at their computer and do this long questionnaire that was seemingly a diagnostic assessment for a bunch of different mental health disorders at once.
I remember noticing that there were OCD-related questions in there, but none of them really related to my experience, so I usually ranked them pretty low on the agree-disagree scale. Like, they would mention specific concerns I didn't have (like contamination) or specific compulsions that I didn't do (most of mine were mental, more ruminating than physically double checking things). Also, I felt much better by this time, so even if that questions had related to my experience, I'm not sure if I would have rated them much higher.
After I finished, the psychiatrist at UC Health graded the questionnaire and was like "oh yeah you actually scored lower than average for OCD, you're all good" — which felt strange to me given my medical history (even if they want to defer to diagnostic assessments, I had scored fairly high on the Y-BOCS, a gold standard diagnostic assessment for OCD, when I was in therapy). I had heard so much about how strict the evaluation was, so it just seemed weirdly permissive. I was expecting to at least have to get a letter from my old therapist or something like that. But of course I felt ready to donate so I wasn't gonna put up a fight for them to deny me! Anyway, the rest of the evaluations all checked out and I had the operation a few months later.
I thought of this when I first read Scott's story, but hearing your experience at the very same hospital made me want to share this. I think it updates me toward the process being very arbitrary and variable depending on the specific people conducting the evaluation. Trying at another hospital makes sense to me, if it's still something you want to pursue.
I considered kidney donation at one point, but my spouse talked me out of it. Their logic was that while kidney donors don't have worse outcomes than the general population, they DO have worse outcomes than those who pass the standards to become donors.
The fact that the medical community elides this distinction was enough to convince me that they're lying, and shouldn't be trusted with my life (or kidney). I'm happy to reconsider if that situation has changed.
The medical community's eager willingness to "tell the noble lie" at every possible perceived opportunity, for even the flimsiest notional "common good" (as revealed in the most public and painful way possible during the COVID years) has killed and will continue to kill countless people.
Yes, but so does illness, and the medical community, despite its many fucking awful flaws, is better at treating illness than the other possible candidates: practitioners of new age bullshit, barbers, religious leaders, sellers of snake oil, and your Aunt Marge.
The question of why people — not all of whom can be accurately described as "idiots who only trust Aunt Marge" — more and more often prefer to visit witch doctors, refuse a vaccine, etc. is IMHO interesting.
The conventional view of “doctoring” seems to be that there are precisely two fundamental types to choose from — “witch” and “legit”. But this IMHO does not fully cover it. It elides an important distinction. There are actually *three* — 1) “witch” ; 2) “legit MD, working for the State or a de-facto appendage thereof.”; lastly, 3) “legit, state-of-the-art MD, working 100% strictly for You, the (paying) patient.”
“1” needs no elaboration. “2” describes every doctor I have ever visited, and likely all of the doctors that you and everyone you know — unless you personally know an oligarch or high official— have ever visited or will ever visit. Chances are that you’ll never encounter a “3” at all, and may even disbelieve entirely in the existence of the distinction between “2” and “3”.
If you or any of the other patients at a practice have ever paid there with “health insurance”, the doctor is a “2”. He is working for the State (and/or its tentacle, the HMO) and his job closer to that of a prison doctor than to that of e.g. Kennedy’s or Kissinger’s personal doctor. That is: to discourage you from visiting him “unnecessarily”; to make it so that when you fall seriously ill, you “die cheaply” (“cheaply” for the organization that employs him, that is; you, OTOH, are likely to lose your savings, house, etc.) ; and in so far as treatment is concerned, “public health” and ROI trump any of your “unreasonable” and potentially expensive personal desires, e.g. to feel energetic, to live past the retirement age in your jurisdiction, etc.
If you’ve read this far — my hypothesis is that witch doctors sucker in increasingly less-stereotypically “illiterate” people — by convincingly simulating the “3” experience. The actual treatment outcome is actually less important (and for a serious condition, often the only difference in practice is the cost. Where the “witch” reliably beats the pants off the MD.)
The “witches” have an increasingly-easier time giving a satisfying, to many, “3”-like experience, especially given as type “2” doctors more and more overtly behave like veterinarians at a feedlot cattle farm. (Or like Mengele, if you’re unlucky. With the difference that Mengele merely painfully murdered his patients, for what he perceived as “the common good”, but at least did not while doing so bankrupt their estates…)
TLDR: many folks would actually rather feel less like feedlot cattle, and possibly leave an intact estate to their heirs, than to live an extra year or two. And they are not necessarily idiots.
I didn’t say the people choosing against seeing doctors were idiots, I said they were getting worse medical care. Skipping medical care altogether will on average reduce life span way more than one or two years. I am quite angry at doctors myself, and in fact am currently seriously considering getting a type 3 doctor, a concierge doctor, despite the fact that will do me real financial harm. So I’m totally with you on anger. I simply would rather receive the type 2 medical care
I loathe than go without monitoring of one fairly scary health problem I have, and routine exams to catch other serious health problems. YMMV
I've personally known two people who recovered from their (to be fair -- mostly iatrogenic, as it happened) conditions after switching to "Type 1" practitioners in desperation. Admittedly this is "anecdote" (incidentally, being insistently told to unconditionally disregard their lived experience in favour of Official stats is one of the reasons why some people end up "setting the bozo bit" on "Type 2" doctors...)
FWIW I'm in USA and sincerely hope to get out -- or at least to die a quick and violent death -- before reaching the age where one is certain to take an interest in doctors. I doubt that I will ever be able to afford the services of a genuine "Type 3". If you can afford one -- you have done very well in life.
OK, you know 2 people who recovered after seeing witch doctors. I know someone who was struck by lightening twice. I am not about to conclude from that that getting struck by lightening is common. You cannot go by the experience of 2 of your friends. The circle of people each of us know is small, and not representative of the population as a whole. You need to look at studies of the differing life spans of people who do and do not receive conventional medical care. If you’re gonna bag seeing doctors you better get good at reading research and understanding statistics so you can do good assessments of various symptoms and health risks. That’s what I do so as to minimize doctor visits.
And by the way, seeing a concierge doc adds $6000 per year to your health costs. You don’t have to be doing all that well to afford it. Actually the fact that I’m going to find that amount painful to part with is pretty good evidence my income’s not that awesome, LOL
Interesting. I agree insurance docs are biased by the insurance, though I don't see how that's the "State" - it's typically either a nonprofit or for-profit health company.
But why do you say you'll never see a 3? If you pay cash for docs, which I always do and many people do, doesn't that make your docs 3s?
Also, paying cash in most cases is actually a lot cheaper than going through insurance since you don't have to pay exorbitant monthly premiums and deductables, you often get discounts, and you don't have to spend many hours dealing with insurance.
Health "insurance" in USA as we know it (which has very little in common with e.g. fire insurance, philosophically or legally) is a creation of the State. And not merely because it is micromanaged by the latter, but also for the reason that the astronomical pharma and procedure prices which create a demand for such "insurance" are atrocities perpetrated, quite deliberately, by the State -- via the patent and licensing cartel regimes, respectively.
> If you pay cash for docs, which I always do and many people do, doesn't that make your docs 3s?
Nope, not any more than paying cash at e.g. "Food Depot" (a grocery in Baltimore where almost all of the customers pay with "food stamps") gets you something other than the very same tinned fish and soups everybody else there is buying.
> paying cash in most cases is actually a lot cheaper than going through insurance
Plausible, until you get a long-term prescription for just about anything. Or any kind of procedure (even routine dental work.)
In a lot of situations you have to do your own research. In fact I'd say you have to do it in most situations where you're dealing with am entity you don't know well, and your interests aren't perfectly aligned with theirs: buying a car or a house, choosing a school or a place to work, donating a kidney, donating to a cause. If the other party wants you to make a certain choice, the info they give you is almost certainly slanted in the direction of the choice they're hoping you'll make. That can happen even if the other party is not conscious of shading the truth or flat-out lyiing..
I agree that the doctors aren't giving full and accurate information to potential kidney donors. It's true that kidney donors are less likely to have kidney disease than non-donors -- but it's also true that they're more likely to develop kidney disease if they donate a kidney than if they don't. So, yeah, you were given an elided version of the truth, but as unfruths go this one does not seem to me so awful. First of all, it's not a flat-out lie. Second, the full truth may be close to the half-truth you were told. Even if people who donate a kidney have more kidney disease later in life than they would if they had not donated, maybe they only do a tiny bit worse -- like 5% worse. Third, it would not surprise me at all if many of the doctors telling that elided truth do not realize it's an elided truth. I seems to me that medical training does not teach doctors much about statistics and research design. I get a publication with info about current medical research, and people are able to leave comments. I've been astonished by the ignorance of stats and research design evidenced by doctors' comments.
It's also worth noting that when Scott told the doctors the radiation from the CAT scans posed a greater risk than kidney donation itself, the doctors were surprised, but did not argue and try to convince Scott he was wrong. So they do not sound hell-bent on proving to him they knew everything and were confident the procedure and accompanying tests had zero risk.
In short, the mild dishonesty of medical professionals regarding kidney transplant risks is not that big a deal if you are realistic about what human transactions are like. Do your own research, as Scott did, and then decide whether you're willing to take on whatever risk there is.
I mean, thanks for validating the approach I already took?
I think part of what irks me so much is that when I've asked doctors why they object to allowing kidneys to be sold (e.g like blood, sperm, or eggs), they've stated that money would destroy the trust between doctor and donor. Yet, for some reason, doctors don't think that THEM getting paid creates any conflict of interest (note that every person in that operating room except for Scott received something of tangible value).
So discovering that (unsurprisingly, to me, and apparently to you) they are indeed tainted by the conflict of interest made their lies particularly galling.
>So discovering that (unsurprisingly, to me, and apparently to you) they are indeed tainted by the conflict of interest
It is not in the least surprising to me that they are tainted by conflict of interest. The first point I made was that you have to assume that any person or organization you do not know well is. We all are to some extent.
Here is an example from my life. I try hard in my professional life to be fair-minded and honest, and not to be greedy and excessively self-protective, but I recently realized that there was an issue I was making no effort at all to be fair-minded about. Psychologists are licensed only in the state where they received their license. To be licensed to practice in another state they have to jump through the other state's hoops, which are likely to be similar but not identical to the ones in their own states. They also have to pay a few hundred dollars for the license. But there is now an agreement called PSYPACT that most states have signed on to that allows psychologists in a PSYPACT state to practice in any other PSYPACT state with much less bureaucratic hassle and expense. I would like to be able to practice in other states, mainly because many of my patients are graduate students, and when they get their degree they usually leave the state. There have been several who wanted to continue working with me via teletherapy but could not because I was not licensed to practice in the state they moved to after graduation. Besides wanting to give these people the continuity they want, there is also some self-interest on my part involved. It's not financial -- I would not have trouble finding new patients to fill the spots vacated by those moving away -- but it's self-interest nevertheless. I *like* these people, and enjoy meeting with them. Also, our work together is going well, and when you take a new patient there is maybe a 30% chance things will work out as well as they are with these people who want to continue seeing me.
So my state legislature is one of the few that has not passed PSYPACT. And I have been walking around for months wondering irritably why the hell the don't just vote for this obviously good piece of legislation. Recently it occurred to me that it's possible that PSYPACT is harmful to some, and that the reason PSYPACT has not been passed is that the group who will be harmed is arguing against it. I don't have any particular group in mind, but it does seem possible that joining PSYPACT gives some professionals an unfair advantage, and harms other. It took me a year to even have that thought. That's an example of reflexive, unintended, self-interest on my part.
> thanks for validating the approach I already took?
I don't think I did validate it. My advice was to assume the medical professionals would not tell you the full, unvarnished truth, and to research the risks yourself. If they were acceptable, go ahead and donate. It seemed to me that what you "researched" was whether doctors tell half-truths and lies about performing a procedure they get paid for. Then, angry because you saw evidence that doctors do indeed do that, you decided not to donate a kidney. It seems to me that the confirmation you got that doctors are indeed somewhat dishonest in a situation where they stand to benefit is highly relevant to how angry you should be at doctors, but irrelevant to the question of whether you should donate a kidney.
Scott has now researched the daylights out of kidney donation safety for you. If you have remaining questions about safety, research them. Then, if overall safety is acceptable, donate. After you are fully recovered, write the doctors a blistering letter about half-truths and conflict of interest. Put up a post here. Publish something, if you can. By the way, I am at least as angry at doctors as you are, because of various events in my own life.
That's good to know. When I was looking into it around 7-8 years ago, it wasn't commonly mentioned. I was also not impressed with the quality of the studies that I reviewed, but it's possible that statistical literacy within the medical profession has improved.
Setting aside the long timeline for scientific development and regulatory approval, why is the ultimate solution not "let's grow infinite kidneys from pluripotent stem cells"?
Likely the same reason why we hear from the EAs "tithe 10% of your salary for mosquito nets" and not "re-legalize DDT". Hence the "re-branded Christianity, on steroids" flavour. Self-flagellators want to feel righteous through painful sacrifice -- rather than by firing a disintegrator ray at the very root of a problem with minimal casualties.
Not to mention that re-legalizing DDT would buy 0 castles.
Throwing around more DDT wouldn't solve the malaria problem at this point - insects had already started measurably developing resistance to it back in the 1950s. That's actually a big part why there was such a push for widespread use, to "finish the job" before it failed completely. Better alternatives eventually emerged: https://worksinprogress.co/issue/why-we-didnt-get-a-malaria-vaccine-sooner
I think this is the ultimate solution obviously. There are groups pursuing multiple approaches.
There is the lab-grown from ipscs to organoids to kidneys pipeline. Here they have trouble vascularising any tissue that grows, so the organoids start necrosing after they grow to a size where oxygen can no longer reach to them via diffusion. There are groups working to solve the vascularisation puzzle, which would be useful for everything, not just kidneys. But its hard. Also from these clumps of renal tissue, its hard to get higher order hierarchy. So in these organoids you have nephrons (which are the functional units of the kidney), but they are all connected to each other like spagheti, whereas in the actual kidney during development they connect through a branching structure, so that the urine can drain out from them. At the moment getting the right signalling is hard.
There are groups working on using pig kidneys. Pig kidneys on their own are not compatible with humans, there will be a very strong acute immune response that will cause necrosis of the kidney and rejection. So these groups change certain genes to reduce the immunogenicity of the pig kidneys. This is hard, there are some prime immune targets, which you can do things about. But there are a lot of antigens the immune system can target. Just from memory I think the most one could stay implanted in a non-human primate under strong immune suppression was a few hundred days.
There is our group at UMC Utrecht, and UCSF group working on a bio-artificial kidney. These rely on some kind of artificial membrane to act as a blood filter which is the job of the glomerulus in the actual kidney, and proximal tubule cells for the resorption of all the stuff we need that makes its way through the filter. Here 3 main challenges are; blood compatibility (the artificial membranes must be blood compatible so proteins must not adhere and block pores and thrombus must not form), strength (membranes must be very strong or designed in such a way as to have low stresses, even a micron scale fracture will take out the whole device), cells must keep alive in the bio-reactor. These are all very substantial challenges that I hope we can overcome.
There are also the chiral approaches which I think you linked to. The end result is a combination of some pig and some human cells which might be less of an issue immunity than the full pig kidneys I mentioned before but still has challenges.
There are a lot of horses in the race, I really hope we find a solution that can get people off dialysis.
Thank you for this thorough response! Fwiw, I recently spoke with the founder of a company called Frontier Bio, which has seen early success with larger-scale vascularization on multiple tissues, working with Mayo and a government agency... Here's a summary of what I learned. I'm sure there are many other groups doing promising work.
Frontier Bio - bio-printing tissues, namely lung tissue, brain tissue and blood vessels on a larger scale than previous startups. They have achieved near 100% vascularization of brain and lung tissue grown from stem cells using a proprietary application of growth factors. Unlike Prellis and Volumetric, they are printing actual cells which self-assemble into larger structures, and growing those cells together in vasculature to sustain them, rather than just printing vessels and seeding cells in a hydrogel. They have one patent from their blood vessel work with the Mayo Clinic and will file for two others for neuro and lung tissue this year. Because they are printing cells, their technology can be applied to drug development as well as testing viral responses. Their near-term prospective buyers are directors of research at pharmaceutical companies; ultimately they hope to print entire organs that could be transplanted.
The ultimate solution is to become immortal beings of pure energy. The medium term solution is to grow infinite kidneys from pluripotent stem cells. The short term solution is to donate.
Scott - I admire and support your generous action, and I agree with you on the near-term solution. Readers interested in new biotechnology approaches may want to read about early success in xenotransplants from pigs: https://archive.is/wbm0F
"But I think about myself at age 20, a young philosophy major studying utilitarianism. If someone had asked me a hypothetical about whether I would donate a kidney to a stranger in need, I probably would have said yes."
I think about my alcohol consumption at age 20 and if someone had asked me a hypothetical whether I would donate a kidney to a stranger in need, I probably would have said no effing way.
I donated in 2021 and have nothing but good things to say about the experience so far. They did take my right, the jury is out on whether this has lead me to become evil.
I suffered from depression as a teenager and was briefly hospitalized at one point. However, the psychiatrist who did my eval was very reasonable about the fact that I am a mentally healthy adult, and it wasn't an obstacle at all. This was through Tufts in Boston, who I would give high marks in every category, including catheter insertion.
In your experience, is there a relationship between kidney disease and being a kidney donor?
Nephrologist:
Pre-donation there is a strong relationship between healthier than average & having great kidney function.
Post donation there is an increased risk of mild kidney disease; people who donate a kidney go on to have kidney failure at a lower risk than that of the general population (but they started out better).
People tend to be very satisfied that they have donated a kidney to a loved one (dialysis stinks).
All of that was for the US …. In countries where people sell kidneys outcomes for the donors are NOT so good.
Me:
Thanks. So in your experience, kidney donors are underrepresented among people with severe kidney disease?
"The Talmud is very clear: that voice is called the evil inclination, and it dwells in the left kidney. There is only one way to shut it off forever. I was ready."
So why you passing off this evil onto some other poor slob? Couldn't you have handed over your right kidney?
That's how you become an effective altruist though, before left kidney donation, thinking about charities gets driven out by intrusive thoughts about crypto, whale puns and factorio train systems. It is only by purging this primeval source of malice that allows a person to write a check to AMF.
Please educate yourself on the natural lifecycle and migratory patterns of EAs before opining in the future.
"The usual rule of thumb is that one extra Sievert = 5% higher risk of dying from cancer, so a 30 mS dose increases death risk about one part in 660."
Aren't you confusing absolute and relative risks here? "5% higher risk" means 5% higher than the *already low absolute risk of getting cancer in the first place*, doesn't it? And that is certainly many orders of magnitude lower than 1 in 660.
EDIT: The correct figure, assuming 5% means relative risk and using the cancer incidence numbers from Google, is 1/4650. There's also the issue that Scott is comparing that number directly to the 1/10,000 risk from surgery despite the fact that death from surgery would be immediate and death from radiation would be many years in the future. Once you take that into account, surgery poses a far greater danger.
"The current accepted values of relative risk are given in Table 2"
Table 2 says it's 5%.
Also the math just doesn't make sense. Google says there are 80 million CT scans per year in the US. If 1/660 of those wound up with cancer then CT scans alone would account for ~10% of all cancer in the country. That's like 1/4 of the total from smoking. There's just no way.
The odds are lifetime. Your link also puts "lifetime risk of radiation-induced carcinogenesis" on a neat little chart (Figure 2), which is similarly ~5% for an adult. I think "5% relative risk" in this context means "added 5% lifetime relative to a person who is not irradiated," not "5% more than previous risk (e.g. 15% so 15.75%)."
> There's just no way.
I mean, it is possible that these statistics are wrong, however, these ARE the statistics that are used. If true I suspect CT scans will not go down in history well.
>I think "5% relative risk" in this context means "added 5% lifetime relative to a person who is not irradiated," not "5% more than previous risk (e.g. 15% so 15.75%)."
I'm fairly sure that's wrong. My linked source clearly delineates absolute from relative risk and explicitly labels the 5% figure as relative:
"Absolute risk is defined as the probability that a person who is disease free at a specific age will develop the disease at a later time following exposure to a risk factor, e.g. the probability of cancer induction following exposure to radiation ... The relative risk model assumes radiation increases the natural incidence of a cancer and it is expressed as a fraction or multiple of the naturally occurring risk"
The absolute lifetime risk of dying from cancer is 1/7, according to Google. So the absolute risk from 1 Sievert is 1/7 * 1/20 = 140 and the absolute risk from 1/33rd of that (30 mS) is 1/140*33 = 1/4620.
There's also the issue that Scott is comparing the radiation risk directly to the surgical risk without taking into account that death from cancer would happen many years into the future while death from surgery would be immediate. He would have to convert both into QALYs lost in which case the risk from surgery would be clearly higher.
This really brings back some memories. I used to live in the Bay Area, and found it a very lonely place for me, working, unable to figure out how to gain friends or love. I was a mess, really.
Then I gave blood and ticked a box about bone-marrow donation, and I was a match. I walked around high, it felt literally the kind of high I'd pay for drugs to get. Whatever dam of brain chemicals that I kept held off until I felt like a worthwhile person, somehow I turned the inaccessible spigot, and I felt authentically good for maybe the first time ever. This is what it must be like to be pregnant, I'm crossing the street for two people!
I was well taken care off, the operation went well, but I got some kind of a bleed in my leg and i was in pain for some months after, but with every twinge I felt the hero. And, well, the leukemia patient died, so I'd also advise anyone donating it's a harder row to hoe to get that outcome information. My leg still (30 years on) has minor problems, but with that meaning attached, I don't count it as a loss; maybe I've even needed that reminder. It's not like I've done much better at the self-care since then really.
I think you did something noble for an individual's life at no small cost to yourself. I don't think its fair to make it about effective altruism in the negative. The individual decision and act was good, and whether or not a single person chooses to explain it was enhancing QALY years, or you felt a strong compassion, or because you felt a religious duty uncoerced doesn't change that. Not everything need be a debate on a universal philosophy or the flaws of such.
i am older now and worry though. It's never good to hear anyone you interact with even slightly has been in the hospital. It's a place we need but never want, if you get my drift.
I hope the recovery from the uti was quick. Hope the wife is ok too. Supporting can have its own fears and worries. Please take it easy.
Yeah, sorry! The hospital kept me in the dark about when exactly the donation would be for a while, and I tried to plan the meetup for when I would definitely be recovered, and I ended up being cleared to fly home two days before and not wanting to rush, sorry.
You wrote: "This is great - my grandfather died of kidney disease, and 10 - 20 more years with him would have meant a lot."
You didn't mention this in your risk calculation for donating! Did you look into the likelihood of developing kidney disease conditional on a family history? Seems like a relevant calculation, I'm guessing that you looked into it and found no increased risk...?
My grandfather smoked like a chimney and ate very poorly and got kidney disease in his late 60s, which I think is almost an expected outcome. I did mention this to the evaluators.
You're a good man, Scott. And this was a good writeup.
I'm old enough that this probably wouldn't be a good choice for me now, and I can't honestly say I'd have done it ten years ago if I'd thought of it. But, in spite of having donated my entire blood supply something like ten times over, and being on the bone marrow donor list most of my adult life, it never even occurred to me that this was a possibility before now. You'd think that, being on the list of people who is clearly open to donating non-vital organs, somebody would have mentioned the possibility. And probably they did at some point, but not in any way I noticed and certainly not with any assessment of the risks.
So there's clearly an information deficit here, and one you've helped deal with. Let's hope that this post gets lots of signal-boosting. Speaking of which, if EA already has the reputation in some circles as Those Wacky Nice Guys Who Keep Giving Away Kidneys, what's the tradeoff on bednets vs. public service announcements re kidney donation?
There was a discussion at an EA meetup about this, but basically if you earn a software developer's salary and you're donating the marginal dollar (I.e. not a fixed amount) it is overdetermined that you save more lives by going to work. If you do want to donate the kidney anyway you have enough PTO, or sick leave in order for this to be "okay" on a, I think QALY adjusted basis. I don't remember what the exact crossover point is.
We mainly did this by comparing the QALY adjusted numbers Scott posted here and compared it against the median recuperation period and plugged in various weekly wages, then compared that to the 5k~ statistical life saved for an AMF donation, so most likely grabbing the Givewell spreadsheet and simple math would be able to regenerate the answer.
Long as we're considering alternatives, how about using those software-developer skills pro bono on building and refining some sort of open-source search engine or wiki for connecting cancer patients with relevant clinical trials? Per https://bessstillman.substack.com/p/please-be-dying-but-not-too-quickly at least some of the relevant data is a matter of public record, but the indexing is staggeringly terrible, and relevant megacorps aren't likely to fix it on their own since that would make strategic intel more accessible to their rivals.
I would be glad to contribute to a project like this. I know that a nephrologist-mathematician couple overhauled the kidney donation algorithm about ten years ago, and were able to drastically extend the average donation chain length.
The post you linked to mentioned that there's companies trying to enter this space, but implies the results are still pretty bad. Do you have any suggestions or resources for possible contribution?
No idea, sorry, only heard of it myself within the past few days and my knowledge of software design is strictly amateur. Asking the author of that linked article might be a reasonable place to start.
Fair enough for EA internally, but there's also the eight billion or so people who aren't Effective Altruists and aren't going to be donating every marginal dollar. Many of those people do donate blood and bone marrow and the like, and some of them might donate kidneys if they knew it was a practical and surprisingly risk-free option. And there's no altruistic cost in their recovery time meaning they earn less money to give to EA causes, because that was never in the cards in the first place.
What's the payoff on trying to get the word out to the non-EA community about the safety and efficacy of non-directed kidney donation. Is there any low-hanging fruit worth going after there?
Unfortunately, the only ideas I have in my head are really long shot stuff, like a kidney donation arc in some sort of mass media tv series or movie glorifying it with details to contact the relevant organizations. I think there was some noise about leafleting converting people to vegetarian / reducing meat consumption in the Animal Welfare wing of EA, but I haven't paid a lot of attention and every year after that I remember hearing it was much less effective than advertised.
Maybe the reverse of raising awareness among EA circles on like, bone marrow and stem cell donations would also work. Not too high impact in terms of net good compared to malaria nets, but more likely to draw from the "feel good" bucket of energy rather than the "oh no the world is full of suffering pits Aaaaaaah!!" bucket.
Sorry, I should do a lot more research for this question, but been feeling low energy.
"When you donate, you can give the organ bank the names of up to five friends or family members who you’re worried might end up in this situation. In exchange for your donation, they will make sure those people get to the top of the list if they ever need a transplant themselves."
Can you change the names later on? I'm thinking about the sorts of incentives this could create.
Rather than direct payments, a lifetime healthcare benefit, like early admission into Medicare or some other coverage, would (a) most directly address people's principle anxiety about the procedure, and (b) be more digestible to those with a strong... sanctity drive if you want to be Haidtian about it.
What I mean is, it might help counter instincts of "ick paying people to do charity is bad" or "ick paying people to do bodily sacrifice is bad." (Even though, at worst, sure it is kind of a sleight of hand. But if people genuinely prefer packaging a fungible benefit in a particular way, why argue?)
The healthcare angle might especially entice those who want to hang a shingle, but are worried about missing out on a system dominated by employer-provided care.
If every solo contractor (in tech, professional services, entertainment) had the option for lifetime free healthcare by donating a liver or kidney, you might close the shortfall.
Tangent, I had assumed opt-out deceased donor policies were widely considered to be an easy policy win here, but recent research seems skeptical, so I'm more unsure:
Specifically the clarification of how Spain's system works in practice surprised me. I'm not quite convinced opt-out is net harmful, but understand the risk of discouraging voluntary donations, so maybe the better investment is in donor counselors for grieving families and improved logistics for abruptly available organs.
(Hang on a second, would UCSF have taken your kidney if you died in a motorcycle accident in their parking lot? Was that their preferred admission path!?)
I think for ethical and PR reasons their goal is to minimize the number of people who donate out of desperation, and using "Medicare admission" as the carrot would mean that some people who get very expensive illnesses that they don't have enough private insurance to pay for would have strong incentives to donate out of desperation, at exactly the time it would be worst for their health.
Definitely, though small patches could help. For one, you noted we already have aggressive, skeptical screening (perhaps to a fault). Beyond that, a benefit that kicks in gradually or with a delay would be another straightforward patch, similar to what might be used to prevent monetary windfalls. Admission to Medicare X years early, tweak X as needed.
This is mainly proposed as a stepwise improvement for market based policies, which must weather similar critiques. At least here, you couldn't donate then use the healthcare to settle gambling debts... unless you have engaged in a very strange series of barters with the mafia.
Alas, some stepwise improvements are still not a big enough step. If someone is strongly against any incentives, this is still one of those. If people are incentive curious, then compensation through health benefits might be a gateway.
Regardless, genuine thanks for what you've done, total badass hero move.
Very cool! Wanted to go through with this earlier in life but my family was adamantly opposed to it. I've been donating blood and figured bone marrow donation would be a good compromise. I got the swab kit for the bone marrow donation and promptly forgot about it - tonight I'll open it. This post was exactly the push I needed. Cheers!
Tangential to the donation issue, but are there any surgeons here who can explain why the incisions for a laparoscopic nephrectomy are on the front of the abdomen? I would have assumed it would be easier to get to the kidneys via the back and/or side.
Not a surgeon, but I will answer since no one else has. By entering the abdomen from the front, the surgeon gets to the peritoneal cavity, which is filled with gas and the laparoscopy instruments are inserted into this space, this gives the surgeon room. The kidneys are behind this cavity. There are other ways of approaching the kidneys, eg from the flank but in general I think that involves making a larger incision.
I had something maybe similar as a child/young teenager. It was numerical patterns (e.g. if I touched something three times on the right, then I had to do it three times on the left). It got more elaborate, and therefore more troublesome, over time (e.g. three times right, three times left, three times right again; then switch to three times left, three times right, then three times left again. Maybe repeat that for a couple of sequences).
We had a set of coloured plates in the house, and when setting the table I would *have* to do "green plate, blue plate, green plate" and so on. I *couldn't* let it be two green plates or two blue plates in sequence. Silly things like that.
Eventually, as I said, it was getting to the point where I recognised that if I didn't do something, it would take over my life. So I broke myself of it by squashing the impulses and refusing to carry out the little rituals. It took time and it was hard, but it worked.
(This was before the days of "tell your parents, go to see a therapist, be diagnosed and treated for a disorder" in my country; at that place and time if I had said anything to anyone, it would have been "oh my God, you're insane, you're a lunatic, you will be sent to the asylum" in reaction).
It may sound funny to talk about setting out plates in colour sequence, and it is by one way of looking at it, but it wasn't funny to experience *having* to do what you know is meaningless for no reason.
Hey, sounds familiar! It's not something I've commented on much over the years, but seeing someone else talk about just squashing the impulses- yeah. It was like an itch that would just get worse, but ignore it enough and it (almost) goes away.
I thought of it as "cultivated weirdness," as it became, for a brief time, a sort of socially-identifying quirk. But thankfully I came to recognize it as a fixable problem before it became too frustrating or became too much of a social trend to indulge that sort of thing.
Even years later, when I have a situation where doing something in a pattern could make sense but isn't necessary for external reasons- I usually avoid doing the pattern.
Ever felt uncomfortable that a painting wasn't hung perfectly level, and you just have to put it right? Or see something out of order and you just have to rearrange it? Everyone has those experiences at a minor level, this is just a larger version of it.
I'm worried that this donation was made out of scrupulosity, which Scott of course has discussed in several posts. Scott's stated reasoning for donating:
> Everything else I try to do, there’s a little voice inside of me which says “Maybe the haters are right, maybe you’re stupid, maybe you’re just doing the easy things. Maybe you’re no good after all, maybe you’ll never be able to figure any of this out. Maybe you should just give up.”
But reading this just makes me feel sad. Like poor guy, he felt so bad about himself that he had to cut out part of his body and donate it to make himself feel worthy. Or as Scott put it in a different article (https://slatestarcodex.com/2015/01/01/untitled/)
> A better word for this untitlement is, perhaps, scrupulosity, where you believe you are uniquely terrible and deserve nothing. Scrupulosity is often linked to obsessive compulsive disorder, which the recent survey suggests nerds have at higher rates than the general population and which is known to be more common in high-IQ people. When I hear my utilitarian friends say things like “I have money and people starving in Africa don’t have money, therefore I am morally obligated to give half of my money to people starving in Africa or else their starvation is my fault” and then actually go and do that – and trust me, these people are always nerds – then as often as not it’s scrupulosity at work.
So maybe it was reasonable to turn him down for the OCD history after all.
I'm biased here. I don't think donating a kidney to a total stranger is a good thing. I share the intuitions of other commentors that it violates the moral value of Purity. And there's something disturbing about doing it for this reason. There's a story about someone who starves himself to death for EA purposes - I can't find it at this moment but I'm sure it's been posted in the comments on Scott's blogs before. This has that flavor to me, even if it's only a 1% chance of death. It's just too self-denying, in a visceral way - a knife is taking out one of your organs! (ok, probably a laproscope, but still.)
Basically, I think we should feel good about ourselves already - we shouldn't need to donate 10% or a kidney to get to that point. (https://slatestarcodex.com/2014/12/19/nobody-is-perfect-everything-is-commensurable/) And if we're not at that point, our resources should go towards ourselves, to fix that problem, rather than give up some part of our life.
It's fascinating how rightists' notion of morality often amounts to "aesthetics", while non-rightists' notion of morality is typically synonymous with "ethics".
Did you originally post this under a different name? It disappeared and then reappeared.
Anyway, I am confused - morality and ethics are synonyms. And the exact relationship of ethics to aesthetics is debated, but most people see being unethical as ugly - I don't see how this is a left/right divide. Can you explain?
In Roger Zelazny's "Lord of Light", when the hero comes back from being punished for a failed rebellion against the 'gods' of that world, he begins a new resistance by reconfiguring Buddhism and establishing a morality based on aesthestics:
"The answer, the justification, is the same for men as it is for gods. Good or ill, say the sages, mean nothing for they are of Samsara. Agree with the sages, who have taught our people for as far as the memory of man may reach. Agree, but consider also a thing of which the sages do not speak. This thing is 'beauty,' which is a word, but look behind the word and consider the Way of the Nameless. And what is the way of the Nameless? It is the Way of Dream. And why does the Nameless dream? This thing is not known to any dweller within Samsara. So ask, rather, what does the Nameless dream?
"The Nameless, of which we are all a part, does dream form. And what is the highest attribute any form may possess? It is beauty. The Nameless, then, is an artist. The problem, therefore, is not one of good or evil, but one of esthetics. To struggle against those who are mighty among dreamers and are mighty for ill, or ugliness, is not to struggle for that which the sages have taught us to be meaningless in terms of Samsara or Nirvana, but rather it is to struggle for the symmetrical dreaming of a dream, in terms of the rhythm and the point, the balance and the antithesis which will make it a thing of beauty. Of this, the sages say nothing. This truth is so simple that they have obviously overlooked it. For this reason, I am bound by the esthetics of the situation to call it to your attention. To struggle against the dreamers who dream ugliness, be they men or gods, cannot but be the will of the Nameless. This struggle will also bear suffering, and so one's karmic burden will be lightened thereby, just as it would be by enduring the ugliness; but this suffering is productive of a higher end in the light of the eternal values of which the sages so often speak.
"Therefore, I say unto you, the esthetics of what you have witnessed this evening were of a high order. You may ask me, then, 'How am I to know that which is beautiful and that which is ugly, and be moved to act thereby?' This question, I say, you must answer for yourself. To do this, first forget what I have spoken, for I have said nothing. Dwell now upon the Nameless."
"I share the intuitions of other commentors that it violates the moral value of Purity."
Please excuse me, I'm rolling on the floor laughing (in Minecraft) here. I thought all this purity stuff was the realm of us knuckledragging conservatives who were way less morally shining bright than the open-minded liberals? That concerns with purity were tied up with the disgust reaction, which is anti-gay and anti-trans and anti- all the good values of current society?
Purity and scrupulosity are often coded with religiosity, and while someone would not be expected to go to this level of heroic virtue, especially if it was deemed to arise from an overweening sense of sinfulness or unworthiness and as an attempt to placate or 'buy off' God, it would indeed be seen as praiseworthy and virtuous:
"In summary, heroic virtue is marked by the cardinal and theological virtues, encompassing faith's foundational role, hope's resilient trust, and divine charity's boundless love. Prudence, justice, fortitude, and temperance further contribute to the virtuous life."
By weighing up potential risks and taking them into account, Scott certainly had demonstrated prudence, and his explanation of his reasons does encompass justice, charity, and hope.
"HEROIC VIRTUE
The performance of extraordinary virtuous actions with readiness and over a period of time. The moral virtues are exercised with ease, while faith, hope, and charity are practiced to an eminent degree. The presence of such virtues is required by the Church as the first step toward canonization. The person who has practiced heroic virtue is declared to be Venerable, and is called a "Servant of God."
"Again, since man by his nature is a social animal, these virtues, in so far as they are in him according to the condition of his nature, are called "social" virtues; since it is by reason of them that man behaves himself well in the conduct of human affairs. It is in this sense that we have been speaking of these virtues until now.
But since it behooves a man to do his utmost to strive onward even to Divine things, as even the Philosopher declares in Ethic. x, 7, and as Scripture often admonishes us—for instance: "Be ye . . . perfect, as your heavenly Father is perfect" (Matthew 5:48), we must needs place some virtues between the social or human virtues, and the exemplar virtues which are Divine. Now these virtues differ by reason of a difference of movement and term: so that some are virtues of men who are on their way and tending towards the Divine similitude; and these are called "perfecting" virtues. Thus prudence, by contemplating the things of God, counts as nothing all things of the world, and directs all the thoughts of the soul to God alone: temperance, so far as nature allows, neglects the needs of the body; fortitude prevents the soul from being afraid of neglecting the body and rising to heavenly things; and justice consists in the soul giving a whole-hearted consent to follow the way thus proposed. Besides these there are the virtues of those who have already attained to the Divine similitude: these are called the "perfect virtues." Thus prudence sees nought else but the things of God; temperance knows no earthly desires; fortitude has no knowledge of passion; and justice, by imitating the Divine Mind, is united thereto by an everlasting covenant. Such as the virtues attributed to the Blessed, or, in this life, to some who are at the summit of perfection."
Not on here, because thank God the level of discourse is generally higher, but it's the online general triumphalist tone of the more-inclined-to-the progressive side: "see, those dumb conservatives only hate gays/trans/whatever because they think they're icky, it's Science!"
"Disgust plays an important role in conservatives’ moral and political judgments, helping to explain why conservatives and liberals differ in their attitudes on issues related to purity. We examined the extent to which the emotion-regulation strategy reappraisal drives the disgust-conservatism relationship. We hypothesized that disgust has less influence on the political and moral judgments of liberals because they tend to regulate disgust reactions through emotional reappraisal more than conservatives. Study 1a found that a greater tendency to reappraise disgust was negatively associated with conservatism, independent of disgust sensitivity. Study 1b replicated this finding, demonstrating that the effect of reappraisal is unique to disgust. In Study 2, liberals condemned a disgusting act less than conservatives, and did so to the extent that they reappraised their initial disgust response. Study 3 manipulated participants’ use of reappraisal when exposed to a video of men kissing. Conservatives instructed to reappraise their emotional reactions subsequently expressed more support for same-sex marriage than conservatives in the control condition, demonstrating attitudes statistically equivalent to liberal participants."
Liberals are reasonable, you see, while conservatives are emotion-driven and thus make irrational decisions.
Along with the studies on "Democrat voters are more educated" and the rest of it. So conservative = Republican = all kinds of bad things, generally dumb rednecks who hate science and know nothing. Conservatives are fearful and thus regard LGBT+, immigrants and the rest as threats. (The "bitter clingers", if you like):
"And when he spoke to a group of his wealthier Golden State backers at a San Francisco fund-raiser last Sunday, Barack Obama took a shot at explaining the yawning cultural gap that separates a Turkeyfoot from a Marin County. "You go into some of these small towns in Pennsylvania, and like a lot of small towns in the Midwest, the jobs have been gone now for 25 years and nothing's replaced them," Obama said. "And they fell through the Clinton Administration, and the Bush Administration, and each successive administration has said that somehow these communities are gonna regenerate and they have not. And it's not surprising then they get bitter, they cling to guns or religion or antipathy to people who aren't like them or anti-immigrant sentiment or anti-trade sentiment as a way to explain their frustrations."
Obama made a problematic judgment call in trying to explain working class culture to a much wealthier audience. He described blue collar Pennsylvanians with a series of what in the eyes of Californians might be considered pure negatives: guns, clinging to religion, antipathy, xenophobia."
"Conservatives, however, are more likely to endorse binding foundations compared with liberals (van Leeuwen & Park, 2009) because these foundations help address motivations toward traditionalism (Malka et al., 2016), cognitive structure and closure, as well as to manage perceptions of threat, all things that tend to be found in higher levels among conservatives compared with liberals (e.g., Jost, 2017)."
(The above study is interesting and worthwhile to read, I just picked that excerpt to show what I mean).
Purity is linked with Authoritarianism, and we all know Authoritarianism is Bad:
"Liberals and conservatives both care about sanctity, but just through different lenses. It is also the case that other factors, more so than purity might better explain variation in moral judgments between conservatives and liberals. Work by Kugler et al. (2014) suggests that higher levels of authoritarianism actually underlie the greater valuation of purity observed among conservatives versus liberals. Relatedly, it may be that greater preoccupation with specific taboos (e.g., being more offended by the use of expletives) is more common in conservatives versus liberals, and these specific concerns might be confused with broader concerns about purity. In other work, Schein and Gray (2015) found evidence across seven studies that perceptions of harm (more so than purity) explained moral diversity across the political spectrum. Differences in moral judgments between liberals and conservatives hinge upon what they each see as causing harm. Together, this work suggests that perhaps earlier claims about the uniqueness of purity to conservatives was exaggerated, perhaps as a result of using a priori conservative moral issues to construct a scale to measure purity (Graham et al., 2011)."
Again, a good study looking at "so what do we mean by purity, anyway?"
A long and detailed study from 2009 that included looking at religious liberals versus religious conservatives (I was amused by the contrast between the Unitarians and the (Southern) Baptists):
"The results supported the moral foundations hypothesis: Liberals refused to make trade-offs on most of the individualizing items but were more willing to perform actions that violated the three binding foundations. Conservatives, in contrast, showed a more even distribution of concerns and reported more unwillingness than did liberals to accept money to act in ways that violate Ingroup, Authority, and Purity concerns. The results also challenged our previous finding that liberals care more than conservatives about Harm and Fairness issues.
Do these results show that we were premature in concluding, from Studies 1 and 2, that liberals care more about Harm and Fairness issues, on average, than do conservatives? We do not think so. Rather, we think there is a general across-the-board political difference on the permissibility of making moral trade-offs."
So mostly it was that the early studies were concluding "liberals are A and B, conservatives are X, Y and Z" and that got taken up and disseminated in a pop-culture way, melding in other studies, that "conservatives are all uneducated and driven by fear, disgust, and authoritarianism".
> I thought all this purity stuff was the realm of us knuckledragging conservatives
I think this is one of the parts of that book that has not aged perfectly. Just look at all the ads: "100% this, free of that, pure whatever, natural, organic, vegan, sustainable". Or the cancellations, shunning, divestment, and boycotts. There are some reasonable guesses as to what's going on - this is all associated with generic modern "blue tribe" progressivism, not the classical liberalism that he confuses with general leftism, and that composed part of the left during his formative years.
Maybe this is a small part of the shape of the "God-shaped hole". Or as I'd put it, our bio-neural-net brains evolved mechanisms to allow humans to bond together in groups, and movements that don't take advantage of all the mechanisms will in general be outcompeted by movements that do, including by having the movements that don't evolve variants that do.
Seems to me -- and at this point I'm irritable and not the least bit god-shaped -- that all this stuff about kidney donation being a violation of our sacred bodily purity and integrity is lipstick on a pig. People are experiencing disgust and anxiety at the thought of being knocked out & cut open, then having a relative stranger extract a slimy, bleeding gobbet of their internal organs. That's a totally understandable and normal reaction to the idea of surgery, and most people facing surgery have some version of it. We did not evolve in circumstances where procedure like that can be carried out with no pain and little danger. Consequently, even when we know that the incision and removal of the kidney will not be felt, and we are very unlikely to suffer serious harm, we are disgusted and horrified by the idea of kidney removal. Why try to turn this primitive but understandable reaction into Beethoven's Fifth?
I can somewhat sympathize with the notion of Purity, but I'm really curious about how that intersects with other values for you. Could you elaborate on where you draw the line for self-sacrifice? Many cultures consider laying down one's life for one's country to be extremely virtuous - does Patriotism also violate your sense of Purity?
Interesting point. I have similar concerns about someone pressured into military service, though that situation seems much less troubling probably because it's less personally invasive and more justified in that a country or cause is not a total stranger.
I'm not completely sure why that situation troubles me less.
I don't know how you would distinguish between being a moral person and being scrupulous even in principle, when you're talking about doing something supererogatory. I will say:
- I'm not usually scrupulous in other situations; for example, I'm semi-vegetarian, but will eat meat when vegetarianism is inconvenient or it looks especially delicious, and not worry about it. I only donate 10% of my income and feel no pressure to donate more.
- I feel good for donating, and I didn't previously feel guilty for not having donated
- When my ex-girlfriend asked me not to donate, I was willing to go along, and would have been willing to go along forever if we'd gotten married.
- I go on and off SSRIs every so often, and this doesn't change my interest in donating at all.
- I think of "everyone has a little voice inside of them that questions their decisions" as part of having a conscience or being human, and I'd be concerned if someone else said they had absolutely zero of this.
Oh man, SSRIs. I probably lost 40 QALYs from SSRIs due to PSSD (permanent genital numbness probably reduced / will reduce my quality 0.8 over 50 years). Still desperately searching for a cure and currently trying estrogen injections. I saw you commented somewhere saying you thought you might have PSSD - have you tried any cures or researched any?
Regarding the morality/scrupulosity distinction, did you see this comment?
Psychologist and OCD specialist Eremolalos identified several criteria to distinguish: (1) driven by a deep, fear of bad consequences if one does not do the behavior, (2) recognizing that the fears are irrational, (3) the rituals and worrying about rituals and bad consequences take up a substantial part of the person’s time and mental energy, to the point whero the person is preoccupied, (4) past history of OCD makes it more likely.
I'm glad to read in this comment that you don't feel guilt or pressure to be a more moral person - from your previous posts on scrupulosity and creepiness it sounded like you did at one point, so I'm surprised and curious when/if that changed. Did you ever write about that?
For me the relevant distinction is, does someone want someone else to be happy (which is healthy) or do they feel a sense of moral obligation, like they should give something up for someone else (unhealthy)?
As far as your last bullet point, that seems to be moving the goalposts quite a bit! The passage of yours I quoted was about an internal critic, a voice there for "everything else" you try to do that says "you're no good, stupid, you should just give up" which is not normal, healthy, or a conscience. That sounds like some pretty seriously negative self-talk and possibly a bit OCD.
>"you're no good, stupid, you should just give up" which is not normal, healthy, or a conscience. That sounds like some pretty seriously negative self-talk and possibly a bit OCD.
It does not sound like OCD at all. I have seen quite a number of people with scrupulosity, and the feeling that drives their scrupulous behavior is nothing like the self-esteem struggles Scott describes. These people are preoccupied with very specific, weird anxieties about the bad things that might happen if they do not carry out their required ritual behaviors often enough and correctly enough. They’re afraid to delete the televised masses they recorded and have not watched because then their nephew who’s on a trip might die in an auto accident. They’re afraid the sore spot on their scalp signals a brain tumor that developed because they were thinking irritable thoughts the last time they drove by a church. Stuff like that. People with scrupulosity actually hardly talk at all about the routine self-esteem issues most people do — things like is my nose too big? Am I just a people pleaser? Does my girlfriend think her ex was smarter than I am? People with scrupulosity don’t have mental space to worry about the small stuff, because they feel in grave danger of catastrophes, and are never sure their religious “observances” are copious and perfect enough to prevent them.
As for Scott’s negative self-talk. I don’t know whether it’s normal and healthy, exactly, but it sure is common. I certainly have thoughts like that at times, and so do my friends. Not many people make it to adulthood without some wounds that left scars that ache sometimes. My closest friend is;, by his own account, the most content he has ever been. He and I are very honest with each other, and he would not say that if it were not true. But there was an incident recently when someone we both know was inexplicably short with him, and he sent me a confused and unhappy text about it, commenting that “I find it easy to imagine that I am irritating.”
I think the best measure of health is not whether somebody is continuously happy and confident (does the state of the world even justify feeling that way?) but how somebody is doing in various important arenas of life. Work: do they enjoy it? are they good at it? are they making enough money? Friends: Do they have a circle of close friends they keep in touch with? Romance: Are they able to date? fall in love? are they married? is their relationship with their spouse good? Family of origin: etc etc. There’s a lot I don’t know about Scott’s life, but the impression I get is that in the main arenas things are at worst pretty good, and in some they’re excellent.
Maybe it's my transhumanism. Permanently reducing my physical potential (even in such a minor way) just rubs me the wrong way. Also, I intend to live a very long time and I don't fancy removing a potentially necessary part of my body.
Agree completely. I have a very negative feeling about this and it feels wrong to me. I suspect the moral value of Purity or Sanctity is relevant here.
Speaking personally, I don't think my attachment to my body is due to concerns of purity. I'll have no problem introducing genetic modifications of all sorts once the technology allows. Sanctity on the other hand is an interesting choice of word. The whole "my body, my temple" thing is horribly cliche, but part of me does think that there's something almost miraculous about living organisms. Life is localized negative entropy, struggling to maintain itself against a universe that seeks to destroy it in a thousand and one ways.
I have this same intuition about my parts. I don't describe it to myself as purity or sanctity---more as integrity, the idea of remaining whole. I got a cadaver ACL, and wisdom teeth taken out, and they feel like violations of wholeness. I *KNOW* this whole-feeling isn't rational. I obviously wouldn't rather be limping around with impacted teeth. But after Scott's article, I looked into donating bone marrow and even 1/430 chance of donating 10% of my bone marrow is still bugging me. Heck, donating blood bugs me for the same reason, and I have donated blood.
I guess I'm just a bad person grasping for excuses as to why I'm not REALLY such a bad person.
I don't think you're a bad person at all, nor is anyone else with those feelings. "Don't remove parts of yourself that are necessary for maintaining homeostasis" strikes me as a VERY good heuristic and a feeling of discomfort whenever you do so strikes me as a very good instinct. Any organism which lacks a sense of the wholeness of its being and the importance of preserving that is probably going to die sooner than (and be outcompeted by) an organism that does.
That doesn't mean there aren't instances when going against that feeling is warranted. Perhaps even morally required. But IMO, the burden of proof is one those making the argument to disrupt the unified functioning of your body (which to his credit, Scott has attempted to do in great detail). Of course, I'm not a utilitarian. So what I consider burden of proof probably differs greatly from many of the people commenting on this article.
It is morally required to give up part of your body if you've promised to give up part of your body and someone else has incurred costs as a result. E.g., if you join the bone marrow donation registry and are later found to be a match, the usual process is:
1. You are told that you are a match, and again asked "are you for sure going to donate your bone marrow now".
2. You answer "Yes, I promise I will do this"
3. The recipient undergoes radiation and/or chemo therapy to kill all of their existing (and cancerous) bone marrow. They will now die soon and badly if they do not receive bone marrow from a matching donor.
4. You in fact donate your bone marrow
5. Everybody lives happily ever after, with the usual caveats.
Somewhere in step 2 or 3, it does become morally obligatory for you to give up part of your body.
I don't think you're a bad person at all. Does it help any with the feeling around blood donations that your red cells will only last around 120 days before being efficiently devoured, so by donating you're likely just giving away some cells that are going to perish anyhow? To be crude, that it's more like excretion than losing precious bodily fluids?
"Normal human red blood cells have an average life span of about 120 days in the circulation after which they are engulfed by macrophages. This is an extremely efficient process as macrophages phagocytose about 5 million erythrocytes every second without any significant release of hemoglobin in the circulation."
I've tried to talk myself into being comfortable with it using arguments like the following:
1. It's no different than a big nosebleed, and those don't bug me.
2. Hey, I can eat more calories!
3. I make new blood all the time.
And there's STILL something about letting Blood Truck Vampires bleed me out that feels like a violation of my wholeness. (To be fair, the one time I did it, they took almost 1.5 pints. I don't know how that's legal or within policy. We were all super-healthy physically active young adults, so the Blood Truck Vampires felt comfortable filling the second bag until the subject started to pass out. I came to a few seconds later, ate my cookie, and went back to work like nothing happened. And so did everyone else.)
Anyway, I'm B+. Blood Truck Vampires want my platelets much more than my blood. Their short lifespan DOES make the idea of donating them less icky. I'll look into it.
Listen, you're a way better person than me, because you do donate blood. I've never done it, despite other family members doing it, mainly out of squeamishness. If they could figure out some way to get my blood without me having to be there, I'd sign up in a flash.
But I'm terrible with needles, just the idea of sticking something into a vein makes me come over all faint, and I have problems when the doctor needs to do a blood draw (seemingly I have small veins or something so it's a five-alarm fire trying to get the one working damn vein to stand out, and then the blood to flow, and collect enough for the fifteen vials they produce, and then afterwards I have bruises and sub-dermal bleeding for days).
I would sue their ass... and you've convinced me to NEVER donate blood, unless I absolutely need to get rid of some for medical reasons (happens sometimes when you supplement lots of testosterone).
You are NOT a bad person. That is YOUR body and no one else has ANY right to any of it. Even if it would save their life, you have the absolute freedom to keep it, no matter what. No one else is getting any part of my body, even after I die.
This is another reason why kidney donation rubs me the wrong way - not only does it violate integrity, but it makes people feel bad for having this important value. I think that's ass-backwards - donating is bad, and wanting to keep your body is good.
Are you sure your aversion to giving a kidney comes from some deep and sacred place? Seems to me it's quite natural to feel anxiety and distress regarding most aspects of the procedure. Being knocked out, having strangers cut you open while you're helpless, blood, pain, injury, fear of death, idea of the sealed up, well-functioning torso being opened up and vulnerable to infection or harm. I felt all that stuff before I had some abdominal surgery, surgery in which nothing whatever was expected to be removed, and in fact nothing was. It didn't feel like it came from a spiritual place or a deep intuition. It felt like anxiety about surgery. We are, after all, wired by evolution to fear injury. We're wired to fear heights and bugs too, and in fact I hate flying and am afraid of spiders -- that doesn't feel a bit spiritual either. It feels like anxiety wiring.
I think it’s natural to be disturbed by harm to your bodily integrity. I once had a tooth pulled unexpectedly. There was little choice because the thing just fell apart while dentist was working on it, and so I said go ahead and pull out what’s left. But I did feel disturbed for a few days afterwards about a part of me being gone. Still, I don’t see any grounds for calling bodily integrity sacred. What does sacred even mean in this context? Apparently you think it means something more than “bothers me to have it compromised.” Why, though? I have a mild phobia of vomiting, and am quite disturbed when somebody vomits in front of me. Does that make vomit-free zones sacred?
Who said I was squeamish? I'm a transhumanist because I desire to use technology to enhance and explore the possibilities of the human condition. Technology is nowhere near the point where I'd be able to replace that part with something equivalent or better. So why on earth would I choose to take an action which permanently reduces my physical capabilities?
That's odd, since my impression of transhumanism is that becoming the superior machine version of you and discarding the squishy organic bits is all part of the attraction. If you intend to be a cyborg, a fully functional android, or have a custom-built dolphin or other species body you can plug your consciousness into, why feel qualms about giving up a kidney that you don't intend to *need* in the Glorious Fully Automated Luxury Gay Space Communism future? If you want a kidney then, the AI can just print fifty out for you!
Transhumanism isn't necessarily wedded to the idea of mechanical augmentations. It's about using technology to enhance your physical and mental capabilities. Taking an action which permanently reduces my body's functioning is directly opposed to that.
As far as the Fully Automated Luxury so on and why I worry about a kidney when the AI can just print me a new one, the rather obvious answer is that currently the AI can't print me a new one. The technology for truly replacing human organs is nowhere near maturity (if it were, we wouldn't be having a debate about the need to donate them) and no one knows when it will be ready. Given that, I prefer to hedge my bets and hang on to the parts of me that allow my body to maintain homeostasis.
Even if we get to the "living a very long time" beyond current human lifespans, that will necessitate removal and replacement of worn-out existing organs, or some kind of adjustments to the organs you possess, in order that they remain functional.
Not to be morbid, but you might also die before ever that time when "we can live to be two hundred!" comes, and your intact organs will go into the grave with you.
But that sounds like I'm trying to push you to donate, and I'm not; you are entitled to say "no, thanks". Just that transhumanism seemed an odd motivator for that stance to me.
Regarding the gap between people who said they would donate vs who do: I think it's like the Peter Singer analogy of saving a drowning child in the forest. If you are the ONLY one present, most people would try to save the child. But if there are millions of children at risk and billions of people who are in a position to save them, there is almost no pressure on you. Similarly, if someone come to you and say: "you are the only match for this person, please give them a kidney because no one else can", about 50% of people are honest in the survey that they would donate in those circumstances. But not in real world circumstances.
It is good to know that friends and family get priority, that was one of the things holding me back before, I will check out my local organization and consider donating more seriously as a result of reading this information. Thank you!
Oddly enough, the rebuttal to the Drowning Child argument came to me last night - Thomson's Violinist:
"You wake up in the morning and find yourself back to back in bed with an unconscious violinist. A famous unconscious violinist. He has been found to have a fatal kidney ailment, and the Society of Music Lovers has canvassed all the available medical records and found that you alone have the right blood type to help. They have therefore kidnapped you, and last night the violinist's circulatory system was plugged into yours, so that your kidneys can be used to extract poisons from his blood as well as your own. [If he is unplugged from you now, he will die; but] in nine months he will have recovered from his ailment, and can safely be unplugged from you."
Since we have already established the principle that the less developed organism has fewer rights than the most developed organism (the rights of the mother, as a fully developed human being, outweigh any putative rights the foetus may have), and since I, being a fully grown human adult with all my brain etc. systems at peak development, am therefore in possession of all full human rights, my rights outweigh those that the Drowning Child may possess.
As an undeveloped human, the Child has only potential or partial rights and does not yet possess full personhood, unlike me. Thus, as in the Violinist experiment, I am within my rights to prioritize my own personal convenience over saving a drowning child. I may feel that my expensive suit is worth more to me, or is more necessary for my needs, than any value saving a drowning child and ruining my suit may produce. Perhaps I need my suit for work? Valuing uninterrupted work and thus my economic welfare over the potential person life is an acceptable reason for abortion, so it's acceptable for the case of the drowning potential person life here as well.
I'm not sure I am convinced by the Violinist argument. If that argument stands, a conjoined twin would have the right to demand to be separated from their weaker sibling even when the surgery would surely kill the weaker twin. And no one in the world would agree such a seperation surgery would be ethical. I'm not arguing against bodily autonomy, mind, I'm just saying the Violinist argument doesn't work in real life conditions.
I don't accept it myself, but I do find it amusing that the same philosopher who accepts the right of parents to abort a pregnancy (and even simply as a thought-experiment, to commit infanticide up to the age of two years old) constructed an appeal to the heart-strings and not the reason with the Drowning Child: "you'd save a child, wouldn't you? you're not a bad person, are you?"
Well, if I have the right to kill my own child for my personal convenience, why am I obligated to save a stranger's child? Why does that make me a bad person if I don't do it?
The Violinist argument is on the pro-choice side, so that's fighting them with their own weapons. As I said, I think it's a terrible analogy, just slightly better than the other one Thomson uses, the Dandelion Seeds one (imagine if you could get pregnant by people seeds that float around like dandelion seeds, and even if you put up screens to keep the seeds out - the correspondence with contraception - yet one gets through and knocks you up, surely all will agree that you have the right to an abortion there!)
As you say: that's not how it works in the real word.
"the right to kill my own child for my personal convenience"
See, this is why pro-choicers find pro-lifers exasperating. Nobody is talking about "the right to kill my own child for my personal convenience." An embryo is not a child! It's not a sentient being. It cannot feel or think, the way a (born) child can. Now, of course, when you abort an embryo, you deny it the chance to become a sentient being. I think that's sad, and I agree with former President Clinton who said that abortion should be safe, legal, and rare.
In my ideal world, everyone who wants to have sex and not have a baby would use effective contraception 100% of the time, and the few (legal) abortions would be reserved for a) people whose contraception failed (it happens even if you do everything right), b) women who got pregnant due to rape, c) women who needed an abortion due to health complications.
And this is why pro-lifers find pro-choicers exasperating.
"An embryo is not a child, it's just a clump of cells!"
"A foetus is not a baby!"
So when does it become a baby? "When/if the mother wants the pregnancy, otherwise it's not anything except 'the products of conception' or similar terms".
Bill may have invented the phrase, but Hillary was the one riding the "safe, legal and rare" mantra until the focus groups said "drop the 'rare' bit, that's shaming women who have abortions":
Abortion only for rape, incest or threat to the life of the mother? Funny, you'd *think* this would be an acceptable compromise option - until the rubber hits the road and then oh boy yeah there should be no limits and no punishment.
Case Number One from the UK: Woman breaks the existing law, terminates viable pregnancy, gets very mild jail sentence - and gets it overturned on the back of a wave of protest about how this is back to the Dark Ages and forcing women to backstreet abortions etc etc etc.:
"A woman who was jailed for terminating her pregnancy after the legal time limit during lockdown will be released from prison and reunited with her children, after winning a court of appeal effort to reduce her sentence.
A court of appeal judge said Carla Foster, 45, needed “compassion, not punishment”, saying her 28-month sentence would be reduced to 14 months and suspended.
Sentencing her last month, Mr Justice Pepperall said Foster would serve half her term in prison and the rest on licence after her release, after she admitted illegally procuring her own abortion when she was between 32 and 34 weeks pregnant."
Remember, this is at 32 weeks of gestation, which means the 'embryo', I'm sorry 'foetus', no I mean 'the contents of the womb' looks like this:
Case Number Two, Nebraska of this year, where a woman was sentenced under the repressive mediaeval religious bigot laws for procuring abortion for her daughter two years ago:
"A Nebraska mother who pleaded guilty to giving her teenage daughter pills for an abortion and helping to burn and bury the fetus was sentenced Friday to two years in prison.
Jessica Burgess, 42, pleaded guilty in July to tampering with human remains, false reporting and providing an abortion after at least 20 weeks of gestation, which is illegal in Nebraska. Madison County District Judge Mark Johnson sentenced her Friday to one year in prison for each count, with the first two to run concurrently. The sentence for the abortion count was ordered to run after the first two, amounting to a two-year sentence."
Clearly the MALE judge is just a sexist pig bigot who wants to punish women for their sexuality:
“I shudder to think, Ms. Burgess, that you have such disrespect for a — call it a human fetus, call it a stillborn child — that you would treat it like yesterday’s trash and not give it some respect in its treatment and disposal,” the judge said. “Our society expects more; it demands more.”
I mean, it wasn't a *child*, as you point out, drosophilist: "it's not a sentient being, it cannot feel or think the way a (born) child can". With such positively Stone Age views held by the men in power, what can one expect? When will the values of a civilised society ever prevail?
"During the legislative session that ended in June, Nebraska lawmakers who opposed Republicans’ efforts to severely restrict abortion access repeatedly cited the Norfolk case, saying it shows state prosecutors would target women who seek abortions for criminal prosecution."
Exactly. Any kinds of limits or interference with the private decision between a woman and her healthcare provider is going to lead to witch hunts by the bigots and zealots.
And back in 1988, abortion was a blessing which served as "a significant expression of her ability to maturely achieve a status of healthy independence":
"And when a woman becomes pregnant within a loving, supportive, respectful relationship; has every option open to her; decides she does not wish to bear a child; and has access to a safe, affordable abortion – there is not a tragedy in sight -- only blessing. The ability to enjoy God’s good gift of sexuality without compromising one’s education, life’s work, or ability to put to use God’s gifts and call is simply blessing.
These are the two things I want you, please, to remember – abortion is a blessing and our work is not done. Let me hear you say it: abortion is a blessing and our work is not done. Abortion is a blessing and our work is not done. Abortion is a blessing and our work is not done.
I want to thank all of you who protect this blessing – who do this work every day: the health care providers, doctors, nurses, technicians, receptionists, who put your lives on the line to care for others (you are heroes -- in my eyes, you are saints); the escorts and the activists; the lobbyists and the clinic defenders; all of you. You’re engaged in holy work."
Hallelujah! But it's us pro-lifers who are the inconsistent ones, right?
Oh yeah, and if you don't want to carry out abortions, then don't go into medicine:
"But let’s be clear, there’s a world of difference between those who engage in such civil disobedience, and pay the price, and doctors and pharmacists who insist that the rest of the world reorder itself to protect their consciences – that others pay the price for their principles.
This isn’t particularly complicated. If your conscience forbids you to carry arms, don’t join the military or become a police officer. If you have qualms about animal experimentation, think hard before choosing to go into medical research. And, if you’re not prepared to provide the full range of reproductive health care (or prescriptions) to any woman who needs it then don’t go into obstetrics and gynecology, or internal or emergency medicine, or pharmacology. Choose another field! We’ll respect your consciences when you begin to take responsibility for them."
If I was the victim in the Violinist scenario, I'd let them proceed with saving his life, but still press charges for kidnapping. If I was a member of the Society of Music Lovers, I'd ASK the One Eligible Donor first, and if he said no, and we decided to kidnap him, I'd turn myself into the police afterward, and throw myself on the mercy of the court.
I think it is a cost argument. A lot of people would argue that 9 months + 18 - 21 years is not a fair sacrifice to demand someone else to make, but wet clothes are a fine sacrifice and we'd all think worse of you for not saving a life if the only cost was wet clothes.
The question is where the line gets drawn. Obviously, no one would blame you if you left the child to drown because there's someone who would shoot you at point blank range if you tried to rescue the child. This implies that you should not sacrifice your own life to save this child, if you do, that's way above and beyond what the correct thing to do is. But if the only risk is that your clothes would get wet and you'd catch a cold, then yes, everyone would judge you. If the risk was that you'd be late for work and lose your job? Hmm. That's fuzzier. My intuition is people would disagree there.
If to save this child, you would have to take on chronic illness for 9 months and then sacrifice personal autonomy and income on the pain of the law for decades afterward? There's evidently disagreement, but I still think I'd be fine not saving the child if it would put me in horrible debt for decades after.
Yeah, the problem with the drowning child analogy is that it ignores proximity and community, which do matter. Someone right there in front of you has a connection with you, some random people dying in shithole countries don't.
Just came here to say that this is awesome man. Being willing to let go of an important body organ is selfless and noble. You valued action over talk. You loved your "neighbor" (a stranger) as yourself. You cared for someone in a massive, humble, and anonymous way. Good on you.
1000% agree on financial incentive for kidney donation (as well as other organs in need, or even blood when in need). This would solve many issues in this realm, and save government/insurers massive many X in the long term.
EDIT: Financial incentive in the form Scott proposes, such as tax credit, seems like a good way to do this, as opposed to cash
"1000% agree on financial incentive for kidney donation (as well as other organs in need, or even blood when in need). This would solve many issues in this realm, and save government/insurers massive many X in the long term."
Not necessarily; the blood transfusion scandal in Ireland (actually, we've had a couple of scandals) and the UK was in part because commercial blood products from the USA, where being paid for blood donation happened, were used for treatment of haemophiliacs:
"Most of the blood products used by the BTSB were from local donations. However, some of it came from American suppliers which included blood from prisoners and drug addicts, who had a high risk of infection."
That's separate from, but included with, the Hepatitis C scandal (blood from a woman who had contracted jaundice caused by Hepatitis C was used to make anti-D human immunoglobulin for the treatment of rhesus negative (blood type) mothers.
"In 1994, the Irish Blood Transfusion Service Board (BTSB) informed the Minister for Health that a blood product they had distributed in 1977 for the treatment of pregnant mothers had been contaminated with the hepatitis C virus. Following a report by an expert group, it was discovered that the BTSB had produced and distributed a second infected batch in 1991. The Government established a Tribunal of Inquiry to establish the facts of the case and also agreed to establish a tribunal for the compensation of victims but seemed to frustrate and delay the applications of these, in some cases terminally, ill women.
This controversy also sparked an examination of the BTSB's lax procedures for screening blood products for the treatment of haemophilia and exposed the infection of many haemophiliacs with HIV, hepatitis B and hepatitis C."
The related scandal in the UK came, again, from use of commercial blood products from the USA:
"n the 1970s and 1980s, a large number of people – most of whom had haemophilia – were infected with hepatitis C and HIV, the virus that leads to acquired immune deficiency syndrome (AIDS), as a result of receiving contaminated clotting factor products. In the United Kingdom, these were supplied by the National Health Service (NHS) with many of the products being imported from the US.
...People with haemophilia were principally infected via the plasma-derived product known as factor VIII, a processed pharmaceutical product sourced from the United States and elsewhere. The creation of such products involved dangerous manufacturing processes. Large groups of paid donors were used (as many as 60,000 per batch, and including prisoners and drug addicts); it only required one infected donor to contaminate an entire batch, which would then infect all of the patients that received that material.[In contrast, this was at a time when the practice of paying donors for whole blood in the United States had effectively ceased; the UK did not import whole blood from abroad, but it did import large quantities of Factor VIII given to those infected (as described in the documentary Factor 8: The Arkansas Prison Blood Scandal). The principal reason that the UK imported these products was that it did not produce enough of its own, and efforts to achieve self-sufficiency were inadequately funded."
Paying people for donating organs may increase supply, but it also increases risk: people who really need what (for the better-off and healthier) is a small amount of money will be people in bad situations and thus at more risk of poor health and things like drug addiction etc. If you make the rewards *too* high (to attract the middle and upper people) then you make the entire process too expensive so the poorer can't afford it; if you make the rewards smaller, the healthy college students who sell their eggs won't be interested and you will get the drug addicts, prisoners, people in rust belt trailer parks who literally have nothing to sell but their bodies, etc.
That's fair. I guess I should have specified the way Scott proposed, something like a tax credit over a certain number of years, as opposed to explicitly cash.
That's probably the best way to do it. The tricky part is that the people who would most benefit from a cash lump sum are going to be also vulnerable in other ways so it is a form of coercion (not just 'have you sold all your spare goods to raise cash' type thinking of means testing but 'have you tried selling a kidney/other organ?') and the people who would do best from tax credits may not want or feel able to donate.
Treating all deaths as 'opt-out' organ donations may tackle this problem of pressured incentives, but then again those organs may not be very useful (e.g. died of old age, died of illness/long standing disorder and so forth). Never mind family objections and maybe the death happening not in hospital so the organ harvesting team can't get there fast enough to preserve the organs.
Whatever we do, there's going to be some downside. That doesn't mean it's not worth doing.
No it's not magic, but at least it then applies to people that make an income. I do think there are still downsides, but I think it's the least bad of all the options we have now. Once kidneys (and other organs) can reliably be made in a lab, this would obviously be unnecessary.
Security guards and gun control are effective measures to prevent school shootings, but so are structures that assure low-threshold contacts for students with troubles with their family or with bullying and while the first might be necessary, the second addresses the problem at an earlier level. On a similar side „making everyone eat healthy and exercise“ doesn’t work if we try to force people to do stuff without changing existing structures. People who have to struggle for their existence tend to chose the path of least resistance, so if the path if least resistance is fast food and cans, they will chose that. However, if we create a path if least resistance that allows people to be healthier on the side, it’s not like they will object. You can improve people‘s health by how you design cities, by making it easy to access structures of every day life (stores, schools, work) on foot or by bike. In Europe there’s another good example in the field of organ donation. In Austria your organs can be used after your brain death by default, unless you disagree, whereas in Germany you have to actively declare that they can be used. Obviously more people are organ donors in Austria, because to actively disagree, you have to mentally engage with the topic and that’s uncomfortable, so not disagreeing is the path of least resistance.
I honestly don't understand why Austria's method isn't used more. I'm totally behind the idea of opting out of organ donation; people should have that freedom. But minus the optout, the dead don't need their organs anymore, why not routinely harvest them for those that DO need them?
NOTA sound much better than nothing, and if the options are NOTA or nothing we should all push NOTA.
But I wonder if NOTA is better than opt-out organ donation by default for everyone in the country. Either in terms of outcomes if each were implemented, or in terms of political feasibility.
My own impression of the situation is that opt-out donation would solve more problems faster, and I like the ethics of it better (financial incentives are always going to be distortionary on other things, given how central money is to all of our systems and incentive programs).
But maybe NOTA is easier to pass politically because it's a tax cut and everyone likes those? Or something about what section of law would have to be changed and how much attention it would get?
Knowing very little about this area, I just wonder if the much smarter and better informed people pushing NOTA have a standard spiel or link I could read about why put effort behind that instead of opt-out. I would love to learn whether I should be changing my standard rhetoric on this topic.
Weird question but, could you say what was the weird pattern you use to touch objects as a kid? Curious cause I used to do that too! In my case the pattern was like A B, then B A - out of some vague sense of "fairness" to object B, so it can go first as well. But now B was first second, which is still not fair, so let's do one inverted round, B A A B. But it's still not 100% symmetrical, so you go B A A B A B B A, but then... Yeah, it was a recursive pattern that could go forever which was, uh, a problem at times.
Recently I found out that this pattern actually has a name, Thue–Morse sequence (OEIS A010060), which I thought was super cool.
Mine was also symmetry-based, but I think I just did the first iteration. But it would also involve "grounding" energies, so if something happened the opposite of the way I predicted I might touch the floor, or if I accidentally touched a man I might accidentally touch a woman to neutralize it, or things along those lines.
"Yeah, it was a recursive pattern that could go forever which was, uh, a problem at times."
That was me, as well. It got to the point that I decided if I don't stop this dead in its tracks now, I will become totally non-functional because I'll be spending large chunks of time keeping the pattern going.
Thank you for the name, at least if I'm nuts I'm not the only one crazy in the same way; misery loves company!
Out of curiosity, did your pattern-matching have to be done in a certain rhythm, that is, to a beat or cadence, and if that got disturbed, have to start over again?
But interestingly, I stopped in pretty much the same fashion. At some point I just had a pep talk with my then ~10 yo self saying dude, you have *got* to stop this because it's actually becoming a bit of a problem. Against all odds, it somehow worked, and the urge to do it went away.
I had a thing like that too as a kid! Mine was ab, then ba to make it even. Then treating the whole block as a unit, I’d do it’s opposite number:Baab. Then I treat everything done so far as a block and do it’s opposite number. And so on, thru many many levels. Would try to see how many levels up I could get without getting confused.
The activity didn’t have a compulsive feel to it though — it was more a mental twiddle that I found soothing.
About a year and a half ago I seriously considered donating. I went through the screening and got approved to donate. During the screening process a doctor mentioned a study about post-operative pain, which I believe was this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790588/
IIUC, the study reports that ~1/20 donors reported chronic pain (that they self-report is due to the operation) years after the operation, and that those that do report a significantly decreased quality of life. The study doesn't have any controls, so it's possible that this is mostly due to the donors being mistaken about the pain being caused by the surgery.
That study gave me enough pause that I so far have not gone through with the donation. Scott, or anyone else, curious to hear your thoughts on it.
Hm. When I query my instinctive emotions (as opposed to a more rational system of ethics), I can say that I'd jump at the chance to donate a kidney (to start a chain) if a close relative or close friend needed one, but that this falls off rapidly the less I know the person and the less I interact with them on a daily basis.
However, if I happened to know the single bit of information that the person in need had previously donated a kidney to a stranger, that instinct goes right back up to somewhere around second-cousin-whom-I-never-see level, which is roughly "answer yes within 1 minute, but it'll take about 30 minutes before my emotions are fully on board".
I suppose this shouldn't have been a surprise given my instincts around reciprocity, but it was shocking to feel that switch flip, even in a hypothetical.
Yeah, but sometimes life is inefficient. If I had two cars, and gave one to a friend who needed one, and then my remaining car broke down, I'd feel foolish, and a bit embarrassed if someone else gave me their spare car. But at the same time, it's just a bit of time-and-place-shifting, as though the third person gave my friend their car instead of me.
I'm considering kidney donation at some point in the future because of this article, but my mental health history is much more recent and stigmatized than yours and I think there's a decent chance I'll be rejected. Hell, there's a chance they'll view my desire to donate as a sign of mental instability. But, I will research it more and talk to friends/family/my psychiatrist/my priest (yeah, not very Rationalist of me) about the idea and maybe fill out that form in 6 months or so.
But the idea of kidney donation did remind me that I've always meant to donate blood but never got around to actually doing it. The one time I actually made it to a donation center I walked up 4 flights of stairs to get there and was rejected for a high "resting" heart rate. So I signed up to donate blood tomorrow and I'm going to try to be a regular blood donor even if kidney donation is off the table.
Just one data point, but I lost a kidney to cancer 23 years ago with no ill effect so far at 81 years old. Ther is noting I do or do not do because of having just one kidney.
I find this absolutely admirable, I wish I eventually grow up to such selfless courage. However the more I think about it the more I run into a conceptual issue.
The thing is, I care about animal suffering almost as much as I care about human suffering. And I fear that by giving a kidney to a random person, the chances that they are a carnist are overwhelming. As a pure counterfactual, my action of saving this person will then cause immense suffering, potentially 10 to 20 years of daily contribution to the torture of conscious beings. I wonder if others have thought about it this way?
This concern is, as the linked paper notes, "far less plausible in poorer parts of the world" where human lives are just as valuable but cause far less suffering to animals due to lower meat consumption and due to less of the meat consumed being from factory farms. And the parts of the world in which we can save the most lives with our donations are also among the parts of the world in which the marginal life saved causes the least animal suffering, so I feel able to continue my anti-malaria donations without worrying.
For myself (in my early 20s), I think I've decided to delay donating a kidney because either (a) American meat consumption will decline over the next 20 years and donating a kidney in my late 30's/early 40's will be morally preferable to doing it now, or (b) American meat consumption won't decline and I'd be uncertain about donating a kidney at any point in time.
I briefly considered traveling abroad to donate a kidney to somebody who causes less animal suffering than the average American, but I imagine global variation in healthcare systems would mess up the (human) QALY calculations that make kidney donation appealing in the first place.
Thank you, interesting to know that others have thought about it! Your approach seems very reasonable, although I do not share your optimism about the future.
I hadn't thought of this, but I agree it's a complicated situation. I can't find anything on whether conditional donation (eg only to vegetarians) is allowed, but knowing bioethicists I expect it isn't. Your best option would be to find some specific vegetarian who needs a kidney and make a deal to give it to them. I don't know where you'd do that search, though.
May I say that I do not understand the mindset of people who will justify abortion, euthanasia, or as here denying life-saving treatment to meat-eaters, but who then worry about poor little shrimps might have the sads?
Animals are not humans. Humans, like "women and children first", get preferential treatment. If you don't want meat-eaters to survive, nobody is asking you to donate blood or tissue or bone marrow or organs or any other thing. Let the sick and the homeless starve and perish, because they might have eaten a burger some time! Spend all your time, emotional effort, and money on the puppies and kitties and shrimp and moo-cows and baa-baas! You are entitled to care about what you want to care about, and not care about what you don't want to care about (after all, I've said the Drowning Child argument is unconvincing to me).
But spare *me* the Sarah Bernhardt performance over "oooh, by anonymously helping a fellow human-being I may be contributing to the torture of conscious beings". If ever my organs are usable after my death, I'm certainly not going to put any conditions on "I don't want them going to annoying vegans, make sure the vegans die first, okay?"
Such an aggressive answer... Why are you so triggered by my comment?
Anyway, as far as I can tell, we are talking about ethics and lucidity here. The whole premise of giving your kidney to a person you have and will never meet implies that you are able to see beyond your intuitions and question what really is good and bad. Go beyond the evolution programming that makes you care only about your family and tribe. In that optics it is perfectly justified to introduce more conscious beings into the picture than only the ones that look like you or are as intelligent as you. Ethics and lucidity.
Back to the aggressive tone, I would recommend that you take a moment to analyse your immediate reaction to my message, and to veganism in general. I used to have the same kind of reactions before I was vegan and one day I realised it was a defence mechanism.
Your purity of donation motivation reminded me of something, people who previously had also insisted on pure untainted donation systems where only the 'right' sort of people received their due.
Black blood and white blood in Johns Hopkins Hospital:
"Working in the blood bank, I immediately confronted a conflict in values. Black blood had to be kept apart from white blood. This was especially galling since apartheid in blood had no scientific basis. Yet it was being practiced in one of the leading medical schools in the country, an institution that prided itself on being a pioneer in promoting science-based medicine while it distinguished donated blood with tags labeled either C (for “colored”) or W (for “white”)."
"Blood transfusion services in South Africa were required by law to collect the blood of people belonging to these different racial/ ethnic groups in separate facilities; the ‘race’ of the donor had to be stated on each unit of blood. The various racial/ethnic categories are associated with a range of other variables, causally and incidentally, and can sometimes serve as a substitute for other variables (such as HIV status) although, in the view of many people, the use of race/ethnicity for the profiling of blood donors is considered to be a stigmatisation of black donors."
Perhaps, under the enlightened guidance of you and those of like minds, a similar system could be implemented: a neat label of "V" for "Virtuous Valiant Vegans" and "C" for the "Cruel Carnist Cannibals"? That would solve the problem of your precious bodily fluids being used to save the lives of the unworthy!
Though this has, at least, presented me with a new rebuttal for the Drowning Child Argument: that child may eat meat, thus by saving them I would be permitting them to grow up and continue to eat meat and torture all the innocent little animals. So I should let them drown and work on saving the shrimps and the flies and the rats instead!
I understand your emotional reaction now. Of course this has nothing to do with my argument, I am completely disinterested in who is the person that receives the donation. I only care about consequences in terms of suffering. Do you get the difference? (I don't mean any aggression or condescendance in this question)
Again, I do not care if they do not share my value. Only consequences. Let me try to rephrase another way. The person could be a serial killer, or a nazi, I would not care. Their suffering matters as much as anyone's. What matters to me is what they do with the rest of their life. If they are going to make other people suffer then no I don't want to give them my kidney. If they don't then yes. Consequences. Do you get it ?
"Caring only about consequences in terms of suffering" is a very derision-worthy moral system because it is subject to many know paradoxes. For example, given any individual shrimp, you should either kill or castrate it immediately, as otherwise it will procreate other shrimps who will , undoubtedly, suffer before their death, but will also procreate other shrimps. At an infinite time horizon a single non-castrated shrimp that you leave alive creates infinite suffering!
You can both pull a man from a burning building and work to promote animal welfare. You want to stop all suffering and that means you act when you can and you refuse to view it as a cosmic scale sort of thing.
i mean of course people have limits but the only correct answer to the trolley problem is "i want to save everyone!" You reject the cosmic scale because the scale is about balance or maximization not suffering itself.
if you read Out of the Silent Planet by C.S. Lewis, Weston is perfectly happy to capture Ransom and offer him up to the Oyarsa as a sacrifice as a greater good for Man, but upon questioning Man is barely an idea to him. He'd do any evil for the wispy idea of Man as essence not creature: as long as something survives anything is justified. break lives to save Life.
The mindset should be unified though. Weston is always a danger.
But real life presents us with versions of the trolley problem all the time. You can chant "I want to save everyone" all the fucking time if you like, but that won't keep you from being the person who either makes one of the possible choices on the trolley problem or walks away from the trolley and its possible victims and lets their fate be decided by luck or other people.
no, real life always has more options. philosophy sucks when it thinks artificially constrained hypotheticals have anything to say about real-world morality. its just "when did you stop beating your wife?" but expected to be taken seriously.
the only answer is to reject the silly framing entirely; human experience is not full of trolley problems because life isn't a/b.
If there's some form of appeal possible, I'd like to make one for Gunflint. This comment is like an optical illusion, or perhaps a "scissor statement" (thank you); when I look at it from one angle, it seems harsh and mocking, but when I look at it from another, it seems like a genuine expression of bafflement. I think Gunflint has been one of the more humane and calm commenters here, and I don't think they would have intended this comment to come out as harshly as I can make it seem when I try to adopt a perspective more like rational_hippy. I feel as though a warning or a single-digit-day ban would have been more appropriate. I don't want to have a repeat of Carl Pham's continuing absence.
I'm going to omit my interpretations of the comment, because I don't think they're worth the space; I could try to explain what I think the most favorable interpretation was, but then I'd feel obligated to first try to explain what I think the least favorable interpretation was, and at that point this would be 5 times the length and mostly me arguing with myself to try to somehow persuade you, and this sentence is already too long. Mostly, I think this type of clash is inevitable in a truly intellectually diverse setting, and I don't think quiet 1-month bans are going to be a good way to handle it. To half-joke, maybe there should be a sign like, "on this blog we take people's ethical systems seriously"? I dunno.
Scott, Substack thought this comment was too long, so I broke it in half. This is PART 1 OF 2.
I think you should greatly reduce gunflint’s one-month sentence. I think just giving him a warning is about the right response. Here are my reasons for obecting to your one-month ban for his post — in fact not just objecting, but being kind of stunned by it.
*It’s not bad enough*.
Let’s apply the rule of 2 out of 3. Is Gunflint’s post true? Well, Gunflint does’t express his reaction in a direct statement that can be supported as true or attacked as false, but I think most readers would grasp the idea he was expressing indirectly: OP’s desire not to have his kidney save a carnist sounds precious and entitled: He presents himself as so big-hearted that he is determined to reduce the suffering not not only of people, but of animals too. But there’s something very self-focused and privileged about his determination to fine-tune his life to the point that he gets to do *precisely* the form of giving that will make him feel pure and perfect. (Gunflint’s mention of single mothers is of a piece with this point: He’s contrasting OP’s expansive view of his life options to those of someone struggling to make it in the real world.) Seems like if Gunflint had laid out his thoughts straightforwardly, as I just did, it would be a reasonable argument against OP’s take on things. Was this argument necessary? Well, if Gunflint had put his thoughts as a direct statement, he certainly would have been advancing the argument about the validity of kidney donation as altruism. Was it kind? Seems kind *enough* anyway. He’s saying indirectly that OP’s idea is very silly, but his way of saying it is a relatively gentleway of getting that across. And in fact things like calling someone’s argument silly happen on here all the time — people clearly don’t see them as a banable level of unkindness.
Gunflint’s comment wasn’t even the worst response to OP. I responded by asking whether there was a case to be made for killing carnists. I think my comment has a passong score because it’s a reductio ad absurdum argument against OP’s view. But it was probably pretty clear to people that it was also a way of making fun of OP’s view. Then Deiseach made fun of OP, in a fairly harsh personal attack: “But spare *me* the Sarah Bernhardt performance over "oooh, by anonymously helping a fellow human-being I may be contributing to the torture of conscious beings". Then Quiop slightly advanced my argument by commenting that since most people are carnists the expected utility of killing any random person is high. Quiop then proceeded tp very overtly make fun of effective altruism: “I think the only way of getting around this is to make a longtermist argument that preserving humans for now is currently the only plausible strategy for making progress towards the ultimate goal of establishing luxury gay space shrimp communism throughout our entire light cone.” I was quite entertained by this sentence, but from the point of view of 2 out of 3 of true, necessary and kind I’d say it’s the least acceptable comment on the thread. Calling the EA vision “luxury gay space shrimp communism” is a way worse way of saying EA is absurd than Gunflint’s remarks about OP leading a privileged life compared to single mothers etc.
*There’s something wrong and dehumanizing about not taking what you know about someone into account when making judgments.*
Gunflint has been posting on ACX the whole 2 years I’ve been here, and I don’t know how long before that. He’s more consistently kind and fair-minded than anyone I can think of, except I guess Nancy Leibowitz. Here’s some recent evidence of that: He made no comment at all about the Palestinian-Israeli situation til a week or 2 after discussion of it started on here, then posted that be felt he should not say express any views without first spending a couple months educating himself about the area and its history. I think the likeliest explanation of Gunflint’s posting the comment he did, which if taken purely at face value is a bunch of unsupported negative insinuations about OP, is that he assumed people would know what he meant — and/or maybe he was tired or preoccupied and forgot for the moment that if you say on here that someone’s whole take on an issue is silly, you’re supposed to back your view up with evidence and arguments.
"He presents himself as so big-hearted that he is determined to reduce the suffering not not only of people, but of animals too. But there’s something very self-focused and privileged about his determination to fine-tune his life to the point that he gets to do *precisely* the form of giving that will make him feel pure and perfect."
Thanks for writing this, now I understand better why I am receiving so much animosity on this comment.
Of course, this is pure interpretation of my motivations and it has no place in a serious rational debate. I am quite disappointed by the level of argumentation in these comments to be honest, a lot of post-hoc rationalisation driven by immediate emotions. A lot of strawmaning, putting words in my mouths... I would have expected more rationality here, but I guess veganism brings out the worst reactions even in the best communities...
I do think it's likely that many people had the same take on it I did, and that's why you got anger back.. I do recognize that that take may not have been accurate. But here's something to think about having to do with the issue of privilege and the attempt to be pure. If you live in the US or another wealthy country, even if you live very modestly, you are the beneficiary of many cruel acts to people and animals even if you do not eat meat or wear leather. Parts of your electronics were probably made by underage workers in poor countries. Preparing data for AI training involves tagging images with terms like "fruit," "yellow," "food," "realistic photo," etc. There are very precise, intricate rules for labelling a given set. This fairly difficult and insanely tedious work is mostly farmed out to Africans. To even qualify for the job you have to speak good English and have a college degree. These workers get paid $8 and hour. It is very isolating work because people with the job are not allowed to tell anyone the details of what the are doing or let them see what you are doing. Every time you use AI, or a web site or service that uses it, you are benefitting from the labor of these people. And so on. Unless you live in a hut and eat only nuts and berries from the forest, you are benefitting from exploitation of others. I'm a vegetarian myself, but have no illusions that no animal was harmed to make possible various things in my life. You might think about the possibility that it makes more sense to put your efforts and smarts to work helping sentient beings, rather than trying to free yourself of any responsibilty for their exploitation.
"You are doing action A. It is causing harm, you should stop doing it like I have."
What I do:
- figure out if that is the case, and balance potential trade-offs
- if that is the case, try to fix it. Ideally not doing action A, if that is feasible at all, if not feasible work towards or find alternate ways to stop the harm
What I will not do is come back at this person and tell them: "There are all these ways you are doing harm yourself. You have only stopped doing action A to feel good about yourself. Stopping doing action A is pointless" and discard the issue.
Not only is it bad epistemology, but it is also literally harmful. This is a very serious point: By using this rhetoric you are attacking people trying to do the right thing, discouraging them, and actually causing harm.
Also, "You might think about the possibility that it makes more sense to put your efforts and smarts to work helping sentient beings, rather than trying to free yourself of any responsibilty for their exploitation."
Why are you assuming that I am not working to help sentient beings?
What makes you think that I am trying to free myself of responsibility?
These are uncharitable assumptions on me and my motives, but I don't see what warrants them in what I have written so far.
BTW, kudos for being very nice and civilized in your argumentation, much appreciated :)
So, Scott, I know you don’t read all the comments, but clearly you read some of them, and it seems to me that by now you must have developed a general sense of what kind of poster Gunflint is. And that kind of goes both ways. I’m pretty sure that he and the other frequent long-time posters have the feeling that you have seen enough of their comments to have a sense of their interests and how they think. Of course your picture of us would not be as vivid as our picture of your interests and how you think, which is based on reading lots of your posts — but it would be the same sort of thing, just in miniature. I have, for instance, the impression that if one of the regulars died you would have a little something to say about them and what you’ll miss. If in fact you don’t — if Gunflint is just a familiar name for you with no information about him attached to it — that’s just not good. We are all sadly misled about you and your forum. I think one thing the regulars like about ACX is a feeling of being known —by other posters, but also by you. People go through a lot of life in settings where they are not known. I hate my rare visits to my internist because her nurse always tries to help me down off the examining table, I assume because of my gray hair etc. I rode my bicycle 3 miles to the appointment, for god’s sake! It’s unpleasant to be Grayhead Stiffjoint to these people, when I am in fact fairly nimble and strong. Regulars here feel known. And most of them care about you. When you dropped out of sight people started to worry out loud about what was up, and speculate uneasily about bad things that might had happened to you. Some thought maybe you’d become a father, and there was talk of giving a gift for the baby. Then you told us about your kidney donation, and there was a tremendous emotional reaction (not all of it positive).
We’re not your friends, exactly, but there’s some kind of personal connection here — surely you sense that, and the fact that we sense it too — and given that connection is it’s just uncivilized not to take into account what you know when responding to posts that don’t make the grade. I understand that there is no simple way to combine use of a simple rule with taking context into account, but I really think kindness and common sense oblige you to. Let’s say you had a huge lawn with nice big shade trees, and strangers often treated your lawn like a park and picnicked there. Maybe you’d have a simple rule about what kind of people you allowed to do that. Maybe if they were quiet you’d ignore them, but if they were rowdy you’d come outside and insist that they leave. Fine. But now say you’re the head of a company and you invite your employees to a company picnic on your grounds. And most of the people who show up are the 100 or so full-time employees whom you know, not the temps and contractors. So if one of the full time employees gets loud and rowdy, you might ask him to quiet down, but you wouldn’t tell him to just get off your lawn and not come back for a month. First of all, you’d probably understand his rowdiness — he always gets that way after a few beers, but he’s a cheerful drunk and never provokes fights. And second, it’s harsh and uncivilized to kick an acquaintance out of your yard. They would be shocked and deeply hurt (as I’m guessing Gunflint is).
So, Scott, I really think that the civilized way to respond to transgressions by a commenter you know, and know to be consistently kind and reasonable, is to take their history into account when you respond to a one-off bad comment of theirs. If you want to be algorithmic about it, you could mentally award the person some credits for a long history of courteous, clear posts that advance the argument, and then throw in some debits proportional to the badness of their problematic post. If they still have a positive balance, you can just let it pass — or send them an email saying “come on, you’re better than that,” or “this post really does not meet community standards. Please don’t post this sort of thing.”
*What’s there to lose? You’re not consistent in applying your algorithm anyway.*
I’m pretty sure you’re not at all consistent in your bans anyhow. A couple months ago I posted a long angry riff about AI honchos’ obliviousness to the humanities. As I remember the thing, it contained no evidence at all for that view — just a mocking portrait of these people as I saw them. You have me half a ban. Carl Pham, very irritated because a newby he’s arguing tells him he has poor reading comprehension, tells newby they’re an excellent example of the Dunning -Kruger effect, and you ban each of them for a week. Meanwhile, I have I have reported about 4 posts since the last time you updated your bans, and everything I reported is still up. I only report posts that, in addition to making unsupported claims, are exceptionally rude or cruel — For example, this bit of commentary about the Israel-Palestine commentary: “What happened to all the dancing in the streets and the outpouring of joy over the greatness of god that we saw on the 7th? Funny, haven't seen too much of that recently! Hahahaha.” That piece of crap is still sitting on the thread, along with a few similar ones on earlier threads. Meanwhile, Gunflint is banned for a month.
And I think, though I’m not quite sure, there are some consistent biases in your bans. You’re more likely to ban a poster for a comment early in a thread, maybe because you’re more likely to read the early parts (though in fact a lot of the really bad shit gets said way later, after things have heated up). And you’re more likely to ban early responders to posts of yours who make negative comments. (They generally are negative comments that do not meet the 2/3 rule, but they’re often not awful comments.). Examples: Your ban of the person who posted the first response to your review of Don”t Look Up. As I recall, it was in fact a harsh and negative comment, but the poster did make some effort to justify his view — maybe saying something like, “don’t you know science doesn’t support any of that?” You banned JDK who commented on one of your posts that it was way too long and wordy. You banned Gunflint for a technically substandard comment criticizing EA in the comments on your kidney donation post.
2. This is the most important point, I kindly (honestly, no sarcasm, I wish you the best man, even if it's hard to get this feeling across in a response like this) encourage you to reflect on it. "Charmed life". Do you look at reality on its own terms? Are you aware of the amount of suffering that exists out there and where it comes from? Or do you prefer to ignore most of it so that life can feel more "charmed"?
3. What do you know about my situation and the problems I am dealing with?
4. Do you know that I am not "a single mother trying to come up with this month's rent"? Or someone in an "equivalent" situation in your eyes?
So is there a case for killing carnists? Seems that would be a highly effective way to reduce animal suffering. Of course the families of the murdered carnist would suffer emotionally, but maybe the total amount of family suffering is less than the total suffering of the animals the person would have eaten if they’d lived.
...and since most people are carnists, the expected utility of murder is positive, even if you don't know whether the person is a carnist or not.
I don't think this is the most persuasive argument for human eliminationism, but as far as I can tell it is a valid one.
(I think the only way of getting around this is to make a longtermist argument that preserving humans for now is currently the only plausible strategy for making progress towards the ultimate goal of establishing luxury gay space shrimp communism throughout our entire light cone.)
I love you last sentence. If our species does colonize other worlds I think what you're really going to get is human beings fighting and fucking on every available level surface. Like always
>> The thing is, I care about animal suffering almost as much as I care about human suffering. And I fear that by giving a kidney to a random person, the chances that they are a carnist are overwhelming. As a pure counterfactual, my action of saving this person will then cause immense suffering, potentially 10 to 20 years of daily contribution to the torture of conscious beings.
Do you extend this principle beyond kidney donation? Thinking of things like:
Is the trolley problem actually simple for you, since all the people tied to the tracks are probably carnists so there’s less net suffering in the world if more of them die?
If you saw a child drowning, or man hit by a car, or found a co-worker collapsed in the office, and you’re the only person there, do you not intervene or dial 911 because “chances they are a carnist are overwhelming?”
Is it your preference that no one intervene to put a stop to or take refugees from crises like the Russian invasion of Ukraine, or earthquakes in Turkey or Haiti, since most of the people dying there likely eat meat anyway? Is FEMA assistance technically a bad thing that actually increases suffering?
(Godwin Alert) Put another way, was it technically a good thing that America turned the boats around and sent Jewish refugees back to Nazi Germany, since most of the people on them probably ate meat? Did that decision operate, in the grand scheme of things, to reduce suffering? If you were in FDR's cabinet, would you be telling him to consider the lives of the helpless animals those refugees and their descendants would surely eat if they were saved?
These things seem to flow from your argument, but if they represent your actual thinking, they seem more parts savage than moral. To an outside observer it looks like window-dressing around a core principle of “I’m not saying I’d kill people personally, but it’s actually good when they die."
But you also say that you admire Scott’s decision to donate a kidney, and describe his act as one of selfless courage, so it seems more likely that there’s some kind of disconnect at work here.
I thought about this recently and I think the obvious answer is to just donate 10% of the $50k to some effective animal charity. I'm not smart enough to do the math, but there's no way it takes more than $50k to offset 15 years, and I personally doubt non-animal meat is over 20 years away.
As someone thinking about donating a kidney, I have two concerns with the cost benefit analysis here. Firstly, it seems to me that the expected utility of donating a kidney today is only positive conditional on it being the case that:
(a) You do not have the opportunity to just save some other person’s life by letting them use your kidney after you die.
And it seems that (a) will only hold if: (1) the organ shortage is solved within your lifetime, and/or (2) your kidney will not be in useable condition after your death. I think an analysis of the probability of (2) would be helpful here.
The other problem: people who actually do donate their kidney to a stranger are clearly a very weird subpopulation, differing in all kinds of ways from those who could be allowed to do so but don’t. So these possible but unwilling doners may not be a good control group for examining the effects of kidney donation on actual doners.
Scott, do you think in retrospect it would have been preferable to just lie about the childhood OCD? Or is this a feasible path for other people with long-ago resolved mental illnesses? Especially if your childhood was before the era of electronic medical records, it seems they wouldn't really know about any past mental illness unless you told them (or unless it was obvious enough that a psych would notice it in the interview, in which case it's not really resolved.)
Counting this as one more piece of evidence for my general rule of being very careful what to tell doctors. They are not on your side. They are on the establishment's side.
Regardless of your reasons for donating a kidney, thank you from a myeloma survivor with kidney failure who does not qualify for a kidney transplant, because I have not had a consistent two-year remission in 8-1/2 years. Thank you for working with UCSF, to whom I donate money for the BioKidney project. If and when the BioKidney becomes widely available, the dialysis industry will be devastated.
- Charity called Anthony Nolan, you just spit in a vial and send it by post
- If you're a match for someone who needs a transplant, then you're contacted
- You then get asked if you are okay with actually going through with it
- You get some injections for a couple of days, then one or two days in hospital with a canula in your wrist taking out your blood, whirling it around to centrifuge out the stem cells, then putting it back
- That's it!
I got invited just over 4 years ago. Mine was slightly more complicated because I have low blood pressure so they ended up fitting a central venous line, which is more invasive than a normal cannula. Also, I freaked out (not a fan of x-rays or needles), and so probably some of the tiredness afterwards was from that. Then I refused to give in to the tiredness and did two gigs the next week, restarted lectures, and did my coursework presentation, which meant it took me a few months to actually recover. Oh also, I got low on Calcium which made me a bit confused.
Like Scott, I meant to do a "this was totally fine" post afterwards, and then ended up just crying at anyone who spoke to me from exhaustion. This is partly because university didn't really do support for being ill, you just had to make up the time. But, if I'd done the op with a job, I'd have just taken a few days of sick leave and it would have been great. So sign up to the register if you want an easier moral high than a kidney (with lower chance of selection) :) - you also get a t-shirt or a mug!
Hi Kayla! Speaking as someone who used to work for Anthony Nolan, yes! You get your expenses reimbursed, including any travels if necessary and a hotel for the night before and after, for you and a companion. They also cover for loss of earning so don’t have to necessary take holiday leave from your work. It’s a very easy process! :)
If some rando in New York starts pouring out long and incredibly well-written essays filled with venom toward political correctness, moving website elements, and the New York Times, we're really going to have to reevaluate a lot of things.
So selling your organs is just generally acceptable by the community? I mean, I personally don't have a strong opinion on the matter, but just checking that's what is being proposed.
I've long been meaning to write a post about my own kidney donor screening process; if this article doesn't give me the push, nothing will.
I planned to donate my left kidney to my father, who had ESRD. As you did, I attempted a cost-benefit analysis and ended up concluding the medical risks to me were negligible. Embarrassingly, the biggest quality-of-life factor on my end was the prospect of changing from a no-significant-medical-events person to a one-significant-event person. Once you donate, doctors will expect you to report for checkups once a year and watch your salt consumption, instead of swanning through life without a care as donation-eligible people can otherwise do.
On my dad's end, the analysis was more complicated: I compared the ~5 quality-adjusted years he could expect with dialysis against the ~10 quality-adjusted years he could expect after a transplant. How does going through hemodialysis 2-3x a week compare with having major surgery (riskier for the recipient than the donor) and then taking immunosuppressants for the rest of one's life? Before COVID it would have been a no-brainer. Now... transplants are still preferable but not overwhelmingly so.
For the EA-inclined, there is a financial aspect as well. Dialysis is EXPENSIVE. If you live in a country with socialized healthcare, I expect you can already donate a kidney out of financial self-interest, NOTA or not.
In the end, I flunked out during psychological screening just as you did. The social worker asked me how I was doing and I told her (like an idiot) that being under lockdown made me feel isolated, and seeing my dad suffer from kidney disease made me feel sad. She then recommended to the doctor that I _not_ donate a kidney to my dad until I got a handle on my dad-sadness, lest I make an irrational decision. Let this be another takeaway: HOSPITAL SOCIAL WORKERS EXIST TO TICK BOXES! DO NOT TREAT THEM LIKE HUMAN BEINGS!
I planned to wait a few months and re-apply, but my dad died of a dialysis mishap a few weeks later. Whether I had passed the sanity test or not would have made no difference.
A way less drastic step that everyone can probably take right now is to figure out how to tell the system that you're cool being an organ donor in the event of an untimely death. For Australia, this is super easy - go to myGov > Medicare and there's an organ donation box you can tick. I can't speak for anywhere else.
So calling all Australians: go to the Medicare page and tick the box saying that you consent to being a post mortem organ donor, if you're not quite ready to part with a kidney yet. That way, if you get hit by a bus tomorrow and never get around to it, your kidney will still help (and hilariously I think it's actually significantly lower effort than getting screened for kidney donation while alive)
Hi, I received a kidney from my father in Februaey this year, and i feel terrible for how it left my father feeling. My drs didnt scan him properly and found out on the operating table that he had three arteries connected to his right kidney. . Now we are both sitting below 50 percent wuen previously my healthy father had a function of 85%. Drs told us it wouldnt be a problem. Now they tell us his kidney was probably too old when they could have mentioned that earlier. Im still fighting off rejection and have a dialysis tube in my heart. Peo0le love to say how easy it is to donate and receive transplant, but its really not. It is a big deal.
I donated my kidney, and found the staff at UCHealth to be awesome. If you're in the Colorado area I would recommend going through them. When I went through the intake, they did not require a CT unless some of the other tests gave them a reason, but that may have changed or may be different depending on your surgeon. I am happy to talk with anyone who's interested and has questions. I donated three years ago, and have had exactly 0 issues since my recovery from surgery, which took about a week for the acute stuff and about 2-3 months to get back to my pre-surgery level of activity.
The Dylan Matthews article was also instrumental in my choice, and I 100% agree with the quote:
> As I’m no doubt the first person to notice, being an adult is hard. You are consistently faced with choices — about your career, about your friendships, about your romantic life, about your family — that have deep moral consequences, and even when you try the best you can, you’re going to get a lot of those choices wrong. And you more often than not won’t know if you got them wrong or right. Maybe you should’ve picked another job, where you could do more good. Maybe you should’ve gone to grad school. Maybe you shouldn’t have moved to a new city. So I was selfishly, deeply gratified to have made at least one choice in my life that I know beyond a shadow of a doubt was the right one.
I feel like donating has raised my floor of how good my life is; no matter what else happens, I did a really good thing that I'm proud of.
BTW, at my very first real "job", circa 1994-95, like my first month, I TOTALLY fell for the "urban legend where you have one-night-stand with hot stranger and wake up in bathtub full of ice with kidney missing" chain/scam e-mail. I forwarded it to the entire company as a DIRE warning.
Boy did I feel stupid.
So, seeing it referenced here, fills me with warm and complex shame, and deep affection for my younger self. I feel closer to you all.
Actually, a practical question for Scott, since he got around a loophole. Some time ago I tried to sign up for a bone marrow donor list. (It sounded like an obviously right thing to do, and, besides, people seemed to think I would be a valuable addition to a special list, simply because I declared (truthfully) that my mitochondrial DNA is almost certainly Amerindian - that, of course, is massively non-special in my place of origin.) Unfortunately, my answers to the questionnaire made me non-eligible - since I had had melanoma in situ a few years back, I had to declare that I had had once had cancer. Question - what is right and what is possible to do in this situation?
Possibilities:
- Tell a technical lie by marking "no" on "has had cancer" rather than checking "yes" and scribbling "but it was melanoma in situ more than two decades ago"
- Just try again while being truthful, it's been more than two decades by now (the donor thing happened well over ten years ago)
- I should have just tried to sign up through other channels
I can see how the general rule is completely sensible here, but I hope we can also see why it shouldn't apply here (it's essentially a certainty that the cancer cells never made it out of the mole; the probability of the contrary is microscopic compared to everything that could go wrong with a bone-marrow transplant).
Bonus question: do things like which subgroup the straight maternal line goes back to actually matter for compatibility purposes?
I'm surprised others haven't brought up my reason for not donating. That is, why should I be the only one in the chain without compensation? Or, why don't the surgeons involved donate their time, why doesn't the hospital donate its facilities, why don't pharmaceutical companies donate their drugs, etc.?
"Second: doing a good thing so you’ll feel good about yourself doesn’t seem healthy. "
If you're just taking up space in the world and doing nothing for others, SHOULD you feel good about yourself? And I can understand having greater care for people you know and love, but could this not also be exploited as well? "I know knocking off Johnny makes you all squeamish, but it's for the family. You wouldn't chicken out on your family, would you?"
Those "others" you talk about helping - are they just sitting around taking up space in the world? Why do you feel good about helping people who are "just taking up space", and how is this the best possible use of your time.
Or, alternately, if the people you are trying to help are themselves trying to help other people, doesn't that at some point trade against everybody helping themselves and skipping the extra transaction costs? Particularly if the "everybody helping everybody" thing is pushed to the EA ideal of donating every marginal dollar, because by that point you've run out of low-hanging fruit on the "helping other people" front.
That just sounds like communal living. Everybody contributes, therefore nobody goes without, therefore nobody just takes up space unless they become physically incapacitated. But because it's understood that they would contribute if they could, and everybody is in the contributing habit anyway, it doesn't feel like a burden.
1) Scott knows that. Jeez, do yoou think that’s news? Donating a kidney and engaging in effective altruism are not mutually exclusive. He can engage just as energetically in EA with one kidney as with 2.
2) You don't quite get the feeling good thing. It's not feeling virtuous. It's not the ethical equivalent of feeling smart because you just got your LSAT score back and it's really high. It's an *emotion* you get from direct giving to a stranger. The first time I felt it was while I was in grad school. I signed up for one of those "give to the needy" Christmas things, mostly because I was bored. I was given the ages, clothing sizes and modest Christmas wish lists of the members of a family, and I went to the mall and bought all the stuff, plus a few items I thought could not fail to please — one was a baseball-sized Hershey kiss. Later, I felt unexpectedly emotional while wrapping everything — suddenly felt very loving towards these strangers. And for days afterwards I daydreamed about them opening the presents, and hoped they were happy with them. I yearned to watch them unwrap them (but to be invisible, so there were no weird awkward thank you’s.). It was definitely a good feeling, but it was not at all a kind of pride. The closest I can come is to say that it put me in touch with a loving side of myself that I did not know existed. It felt good to manifest that side. I do understand that this sort of direct giving is not an effective use of resources. The $100 or so I spent on presents could no doubt have been used much more effectively, produced much more total human benefit. But I think direct giving, while statistically ineffective, is a good spiritual practice for EAs and others. It puts you in touch with a side of you that wants to give more.
3) Are you aware that you can’t give a kidney to just anyone? You have to be a match on most of 6 (I think it’s 6) different variables — things like blood type. While family members are more likely to be matches , it’s far from a sure thing even for siblings and parents, who are the relatives you share the most genes with. With them there is I believe about a 50% chance that you will be a half-match (match on half the variables) which is decent but not great. Once you get to aunts and uncles and cousins, the chances drop pretty low. So let’s think about the numbers, as EA’s do. Scott is 38. He has 12 more years before he’s too old to be a desirable donor. He has 2 parents & I believe one sibling. Regarding kids, let’s think large and assume he will father 3. So he will have 6 relatives with whom there’s a decent but not great chance he’d be a match. And what are the chances one of them will need a kidney in the next 12 years? Just looked up what percent of population currently has end stage kidney disease. It’s about 1 person in 500. I'm sure the majority of them are adults, and half of Scott's 6 future relatives in our model will be children during the 12 years when he is young enough to donate. So overall it’s quite unlikely that one of Scott’s close relatives will need a transplant in the next few years, and even unlikelier that somebody will need one AND he will be a match. Given all that, does it make sense to hang on to his spare kidney on the off chance a close relative will need it in the next 12 years?
He said in another comment that it's just overall health, but he'd think twice after 50 or so.
At least in Britain (? Not sure about country) they have a system where you can "trade" for optimal kidneys, where, say there's several donors with incompatible relatives with failing kidneys, and they keep getting matched up with another incompatible donor compatible receiver pair, until s eventually someone comes in and completes the chain, so then all the recipients get an appropriate kidney and all donors have donated.
And what if the person you may have wanted on that list is a spouse you haven't yet met or a child who has not yet been born?
Not even to mention that (AFAIK) organ transplants to blood relations have a measurably better prognosis than ones to unrelated people.
Yes, it's already a thing: https://en.wikipedia.org/wiki/Kidney_paired_donation
I’d love to know if other women have considered this and have better info on the risk of being one kidney’d for future pregnancies. I know pregnancy taxes your kidneys more than ordinary life, and since I have a history of miscarriage I’ve been reluctant to add any new risks.
(I’m also curious if having one kidney means being risked out by eg a birthing center or a midwifery practice).
I think it's a fair consideration? At a skim this turns up: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747242/
They did note some pregnancy-associated risk increase post-donation, such as a higher likelihood of fetal loss (19.2% vs. 11.3%), gestational diabetes (2.7% vs. 0.7%), gestational hypertension (5.7% vs. 0.6%), proteinuria (4.3% vs. 1.1%) and preeclampsia (5.5% vs. 0.8%). Also, a lower likelihood of full-term deliveries (73.7% vs. 84.6%).
These outcomes were more likely in people's post-donation pregnancies, than their pre-donation pregnancies. Sounds like they tried to model age in, but they admit that it is hard to be fully sure they factored out age effects. Kidney donation screening seems to have meant the pre-donation baseline started out at better than genpop, and they characterized the post-donation numbers as similar to genpop and lower than individuals with kidney disease? Looks like a risk-increase, though.
Based on those numbers I would recommend to delay donating until you are done having kids.
Those numbers seem pretty bad, compared to Scott's numbers. Maybe better to leave the donating to those with less risk.
Now that I have two kids, I wouldn't actually do it.
One of my kids is disabled (autism) and even a tiny increased risk of death or shortened lifespan is too risky for me, because he's probably going to need life long support from me.
It's also reduced my donations to charity significantly for the same reason, I need to save all the money I can for after I die because he's unlikely to be able to have a job in the future.
In retrospect I should have skipped having kids entirely and done kidney donation instead, but hindsight is 20/20.
I am stoked about using IVF with embryo selection to select the embryos with the fewest risky variants and the fewest de novo mutations. Reducing the rates of de novo mutations and risky variants by 1SD each generation is a huge boon to health. In 50 years your kid's disability will be much rarer if regulators can get out of the way and let capitalism make it cheaper and more convenient.
"In 50 years your kid's disability will be much rarer if regulators can get out of the way and let capitalism make it cheaper and more convenient."
Even cheaper and more convenient if regulators get out of the way and just allow the crips and 'tards to be aborted, right? IVF etc. is expensive and time-consuming, just dump the failed attempt and try again, and if your genes are too mucked-up to produce healthy kids, stop trying to have kids. That's the sensible solution, yes?
Yes, and I say that unironically. I don't want to get into an abortion argument because those are tiresome and repetitive, but I'm curious about your counterargument to this: "if your genes are too mucked-up to produce healthy kids, stop trying to have kids"
What's wrong with people voluntarily choosing not to have kids to spare them horrible suffering?
Sure, if it's a disease that causes horrible suffering. I'm not sure even acute enough autism to need lifelong support inflicts "horrible suffering," to go back to the conversation starter.
We actually had both our kids fully sequenced and the polygenic score for autism is actually higher in my neurotypical kid than in my autistic one. At the current level of technology it's clear the power is just not there yet.
a lot of the variation in autism is de novo mutations that won't show up in a PGS
I remember talking to someone in this field a while ago who suggested that it is in fact still better to have natural conception if possible vs pre-screened IVF because of an inherent lower risk of mutations as seen in (some?) studies. I think this is something that people might want to look into before deciding to pursue genetic screening for embryos.
parental age (especially the father's age) is the biggest modifiable risk factor for de novo mutations. IVF users would tend to be older and sicker than natural conceptioners so it's probably just an artifact unless they explicitly controlled for that. But anyway they can just measure the number of DNMs in each embryo after the embryos are made and factor that into the choice of which embryos to use.
also the paternal age DNM problem could be completely avoided if dudes freeze sperm when they're 16. Providing that for free would be 100x worth it for a country with cradle to grave nationalized healthcare.
have you considered secondary guarantee life insurance?
I remember looking into this before I donated my kidney, and the only risk that I recall there being solid evidence for was a slight increase in the risk of pre-eclampsia. That said, it's totally reasonable to wait until you're done having kids, especially if you've had problems in the past.
In the realm of anecdotes: I had an uncomplicated pregnancy and now I have a beautiful, healthy one-month-old!
Out of curiosity did you donate your kidney to a stranger like Scott did?
My guess would be that "donating your kidney without a known recipient" falls in to the category of things that males are far more likely to do than females.
Obviously my theory is untestable if indeed there are greater risks for women (either for their bodily health or reproductive health), but simply based on my limited knowledge of male and female psychology I would imagine that (unless it became the social norm or otherwise "cool") the number of men donating kidneys to unknown participants compared to the number of women donating kidneys to unknown participants would be at least 5 to 1.
Like I said though, if indeed there are greater risks to women then my theory can be proven wrong (if indeed there is greater parity than 5 to 1) but can't be proven right (because rational concerns wouldn't be gender equivalent).
I did donate my kidney to a stranger, actually. Let this be a lesson to you about making assumptions about people based on their gender, especially when those people are rationalists.
Hey, I hedged every which way to Sunday! 😂 Hell, my comment was even an attempt to CALL FOR MY CORRECTION!
Let that be a lesson to YOU about making assumptions about a stranger. 😉
I am 100% certain that what I did was as close to truth-seeking and overcoming bias as is possible to one of flesh and blood.
All that said, text fails to convey... pretty much everything. So let me say that I'm writing this with a sly smirk on my face as a friend joshing you because I'm reading your comment as coming from the same intent.
If you're serious though, I'd be glad to have an octagon death match of unbiasedness. We could make a youtube video attempting to uncover each other's irrationalities. Uncovering my own bias is like my favorite thing!
All that said, A. I still assume that the numbers are 5:1 in cultures where it isn't considered within the bounds of normalcy (it amazes me to learn that there's a community where it IS considered normal! and B. Bravo!!!!! 👏👏👏❣️❣️❣️❣️❣️❣️❣️❣️❣️❣️ A thousand or million times bravo What you did is absolutely amazing. You are a wonderful beautiful person. As a human on this planet I *personally* thank you for contributing to us and wish you snd your family every single happiness. Really, may there be more people like you. 🙏
If I could live my life over again, I'd donate a kidney at age 20-25 —i.e., old enough to be an Official Adult but too young to have kids. That seems like a good option for women who intend to have kids, to balance out the risks of potential pregnancy which will probably happen at 25-40 and the risk of an aging kidney being less useful.
I (25F) donated this year (also at Weill Cornell!), and my personal calculation was that because I'm already at very low risk of pre-eclampsia due to various factors, I could stomach being at slightly higher risk. My medical team told me that if/when I get pregnant, the pregnancy will automatically be treated as a higher-risk pregnancy, and appropriate precautions will be taken. That being said, I've never been pregnant, so my "calculations" were based on vibes. I also figured it would be much, much easier logistically to donate before I had kids than after. Also - I personally would be fully open to adoption in the event I was unable to have kids biologically, so for me personally it didn't necessarily feel like any of my options were being taken away.
Other than in the immediate hours after donating, when I was in a good deal of pain (and until I heard that the transplant had gone well and my recipient was recovering, which, like Scott said, put things into perspective), I have not regretted my donation for a moment. It is in all likelihood the greatest thing I'll do with my life (in an optimistic way!).
Thank you for donating, and that's a very helpful comment! I have sought out practices (midwives, birthing centers) that take an aggressive approach to "risking out" patients and banning them. Attempting a VBAC got me risked out from a group of birthing center midwives and accepted by a group of hospital midwives (it worked!).
To me, this suggests that it's not a good idea for women to donate a kidney if they suspect they'd strongly like to try home births, birthing center births, low intervention births and the lack of a kidney means they'll be risked out of compatible practices.
I'm more confident the increase in risk would lead to being dropped by those practitioners than that it *should.* But it's rare enough that I suspect many will not be up to consider the risk and run the numbers but will simple say "that's non-standard risk and we don't do it."
As a post pregnancy x2 woman, I would advise waiting until you have had children. There are just so many surprising changes to one's body during and following pregnancy that if healthy offspring with a healthy mom are your priority, holding off on adding an additional possible complication seems wise.
I think I'd have been very excited about donating a spare kidney when my kids were elementary school age if that had been at all a thing I knew about and if I'd been in a different relationship (my husband so objected to my donating blood that I stopped, even though I'd been doing it with no noticeable problems for 15 years, and went back to donating after we separated, again with no problems).
I believe that bodily integrity has a value in and of itself, independent of any utilitarian calculation around whether you will need a particular organ. (I don't mean "integrity" in some metaphorical sense. I mean it in the literal sense of keeping the physical phenotype in accord with its basic genotypic design.) Obviously, there will be a thousand and one exceptions in practice. (Fair warning: if you respond by giving me examples of such exceptions, I will be extremely unimpressed.) Every time one gives oneself a paper cut, one is violating bodily integrity in some small way. Of course. But I try not to do that on purpose, except perhaps to treat some greater medical ailment.
If you insist on utilitarianism, I suppose you could justify my position with some kind of rule-utilitarianism as opposed to act-utilitarianism. But I'm not a utilitarian at all.
I guess I don't understand what it means to assert a strange moral rule that there's no a priori reason to expect, admit that there are many exceptions where it's not true and you can't explain why, then continue to assert that it's a moral rule rather than a heuristic.
A: "I went to the park yesterday"
B: "What? You should never go to things beginning with P!"
A: "But don't people go to the port and the parlor and the palace all the time? And you never object to that?"
B: "Yes, obviously there are a thousand and one exceptions in practice. But you shouldn't go to the park. That's just how moral law works."
I don't know how you could possibly argue with B at this point, it just doesn't seem like there's any positive reason to believe him.
Keep your bodily integrity, if you must, and celebrate those who save lives in real time in the real world! If Sam bankman Fried just gave a body part instead of his soul, we’d all be better off
Is "keep one's body intact" really a "strange moral rule?"
Your story about "not going to places that begin with P" is the kind of story I'd expect a utilitarian to tell. And yet, "keep my body intact" doesn't seem anything at all to me like "don't go to places that begin with P."
Why might that be? Perhaps the utilitarian stories are constructed –– designed? –– to filter out consideration of factors that cannot easily be verbally articulated and weighed for calculation, on the assumption –– undemonstrated and dubious! –– that such factors must be unimportant. But it seems to me that such factors, especially in regard to matters of the body, sex, and relations, might be very important indeed.
To ward off annoying evangelical utilitarians, you just tell them that you have a utility function different from theirs (I think that's actually just true, even if you reject the label, but I might be using the term idiosyncratically). They ought to know they can't argue with that.
You're right –– but only in the trivial sense that any norm can be reproduced by sculpting a custom utility function for it. I understand that, but consider it an unhelpful exercise.
Yeah, I agree: I don't think it's a useful exercise either. It's just that "utilitarianism" is as meaningful a name of the doctrine as "do-the-right-thing-ism," when it usually means something like "maximize-the-total-global-QALYs-ism" which doesn't correspond very closely to mine. (The alternative doctrines that try to describe themselves without reference to to utility functions strike me as either incoherent or downright evil, so this kind of trivial description is the best I've got. The detail is then in WHAT my utility function is, loyalty, honor, duty, etc.)
That's one of many reasons I don't consider myself a utilitarian. You can game the system to come up with any outcome you want, and it gives you the freedom to justify that. SBF probably still feels justified, even with the outright fraud.
If you posit that there are more utils in murdering people, you can justify that too. Maybe you're the Punisher, killing the worst people that the law can't handle. Or you've done the math and some people's lives just aren't worth living, so it's worth the hit to your utils to save them.
I'm a deontologist, so I just say that murder is wrong.
I think the example of SBF has been too quickly and too defensively bracketed. ("Oh, it turned out that he was just a fraud, not a *real* EA." Hmm, not a true Scotsman, you mean?)
My reading of SBF is that he was sincere, in the sense of sincerely following his Maximum Expected Utility, as he calculated it, and that led him to disregard ethical norms that did not accord with the latter.
In fact, AND THIS IS THE CRUCIAL BIT, like Scott, he would have demanded that those ethical norms be justified in terms of Maximum Expected Utility, and then dismissed them as "strange" when they were not.
In Sweden, we have a huge problem with "people the law can't handle," and a fair share of the populace is ready to applaud any such Punisher killing them off in the name of total utility. If so, we'll see where that takes us (Nazi Germany or El Salvador?). However, it will have to be compared to where we're heading now (probably Mexico).
Deontologically self-imposed limitations might eventually face ethical opportunity costs that make you want to reconsider them. Then the cultural evolutionary selection processes will undergo some learning that includes selecting away the principled. This is not a normative point but a descriptive one.
Any one person's ethical stance will, of course, be that particular individual's decision. The bigger issue is what norm will prevail, under what circumstances.
There's a complexity about that which is about comparison of utility between people and aggregation of utility across populations.
Most kinds of utilitarianism say that you should aspire to maximize total or average utility (or some variant of those meant to address paradoxes and counterintuitive results), of "everyone". In that case your different utility function would mean that *your personal contribution* to total (or average or whatever) global utility would be weird or hard to predict, but that doesn't change the utilitarian goal of trying to maximize something globally, nor the utilitarian moral intuition that *you, too* should being trying to maximize something globally!
(There's a whole set of criticisms of utilitarianism based on the conceptual difficulties of how to compare or aggregate utilities between different subjects-of-experience.)
This is called consequentialism-but-not-utilitarianism.
A more considering stance would recognize that humans don't have complete degrees of freedom in their divergence in values, and so while there can be a legitimate underlying value difference, it can be exacerbated beyond the value it would have on reflection! So it can still be worthwhile to talk over it.
"I want to keep my body intact because it feels right to me" is perfectly fine and unsurprising.
"As a moral rule, one ought to keep one's body intact" is weird as hell and you haven't even made an attempt to justify it. The only way I could even imagine making an attempt to justify it would be through some form of divine command theory... but if you think you have a decent justification, I'm all ears.
Exactly. My first thought was of the now-defunct proscription in the Catholic Church against cremation and the revulsion of Catholic parents at the thought of ear-piercing or any other body modification. The point was that Christ was going to want to resurrect your whole body on Judgment Day. That was their strong argument for keeping one's body intact. It's a belief, nothing more. OK for you if that's how you feel, but not compelling to anyone who doesn't share that feeling/belief.
> Perhaps the utilitarian stories are constructed –– designed? –– to filter out consideration of factors that cannot easily be verbally articulated and weighed for calculation, on the assumption –– undemonstrated and dubious! –– that such factors must be unimportant.
There's a bunch of posts on the EffectiveAltruism forum and LessWrong about considerations like these, acting like EA is just naive utilitarianism is just a strawman imo.
You can infact have a higher value for bodily integrity than others! It just does actually seem like an odd value to settle on, especially when its qualified with a bunch of exceptions, which is what Scott is getting at. This is still compatible with consequentialism, and would just mean that you have a higher personal-cost for certain kidney operations.
I agree that having my body altered is significant, but that's primarily due to a combination of the unpleasantness, cost, and the possible problems that come from it (Scott's description of how the surgery before and after made my mind rate the cost for donating a kidney higher than I thought it was from vague thoughts before the post). But also, while it would be very uncomfortable to get a cybernetic eye that works better than human eyes (once we have them), I'd still be very interested to get them. It would just be worth the cost.
I think what Scott is getting at is that your form of bodily integrity value is an odd sort of rule, that makes less sense than other rules that are common (such as do not lie, do not murder). It makes sense as something to prefer, but doesn't make sense as something that tries to be set down as a law like 'do not lie' often tries to be.
Yeah, maybe; how do you feel about blood donation?
Or lifting weights? Footraces? Tattoos? Haircuts?
* Blood donation (as commonly practiced) impairs no function, as blood is renewable within the body. In fact, if anything, it's mildly good for you.
* Lifting weights and other forms of exercise straightforwardly improve natural function.
* Haircuts, etc. are indifferent.
"Keeping one's body 'intact' has intrinsic rather than instrumental value", which was what you said originally (slightly paphrased but I don't think misrepresented), does seem a bit strange, yes. Granted, the word "intact" has positive connotations, typically if asked if I'd prefer thing x to be intact, I'll say yes for most xes I care about. But when you try to figure out what the nice-sounding-thing "keep your body intact" means in practice, there's plenty of room for disagreement about what it should mean and whether it would be good.
If the meaning you intend by "keep your body intact" doesn't ground out in it being functional and healthy (which a body can be after an organ donation, in the same way as it can be after things I imagine you were thinking of as silly counter-examples, like hair loss and clipping your nails), and doesn't draw the line between an intact body and say a broken or improperly divided one in a way that recognizes the value of being able to function well, then I think whatever your definition of intactness/integrity is is likely on the wrong track, and would be strange to treat as a moral good. Also, if your values of bodily-intactness are selfish and don't recognize the goodness of giving something of your own body to help someone else's body function well and be more intact than it was (if, in other words, you wouldn't endorse trading a little of your body's intactness to help someone else a lot with theirs), then, I mean, ok, that's what you think is good. Seems strange and unconvincing to me.
If, however, you define bodily intactness with reference to bodies with parts that function well together, recognizing the physical fact that we're all ships of theseus, and if you are willing to agree that more people with intact bodies is better, and giving a bit of your body that makes you only very marginally less "intact" than you were to someone so theirs can be more intact, would be a good and generous act because of the effects on bodily intactness, then there really isn't a disagreement here, just a confusion in use of words. But it seems like you think organ donation would be bad by your moral values because it means you're no longer intact, so there is ovbiously some more substantive disagreement here, I guess.
I would agree with him that keeping your body intact has intrinsic value. That doesn't mean there aren't other values - helping others is another value. That does mean there is a trade-off, and you lose something above and beyond the inconvenience and pain and risk of complications.
OK, that's fine, I suppose. I am a left leg below knee amputee, so on thinking about this more it occurs to me that it is possible that my sense of whether and why bodily intactness matters relies less on intuition and more on explicitly thinking about my situation than most people :D. And so thinking that intactness matters might be something that a lot of people think, and I just don't, unless there's an impact on functionality, and it seemed strange to me because I'm just different. But actually, if we're just talking about intuitions about what is valuable, I can also see why "don't remove bits of me" is a fairly good heuristic generally, and this was emphatically more true before modern medicine. Sometimes the modern environment means our intuitions about what is good, formed in a very different environment, can lead us astray.
Do you feel like you lost something valuable, over and above practical difficulties and medical issues?
Shorter and more to the point than my earlier post: valuing keeping one's body intact as an intrinsic good absent any reference to its function and health would be a strange moral rule, yes.
Valuing an intact body because of how it's functional when intact is not strange, but it is also not incompatible with organ donation.
The fact that you find organ donation goes against your moral value of intactness, strongly suggests you place a strange value on keeping yourself "intact" even when you don't need to for health and function. One wonders what other things you might object to on grounds of bodily integrity.
I mean... keeping the phenotype in accord with the genotype's design? First off, your genotype wasn't designed. But secondly, why do you care about that? Would you care about that even in the case where your genotype included Huntington's or some other thing that made your life bad? If you had the gene for increased risk of breast cancer, would you object to surgical intervention, in that the integrity-respecting thing to do is die of breast cancer?
Unless your "integrity" value grounds out in a healthy and functioning body, then yes, it would be strange.
I kind of agree with SA that your point here is put pretty weirdly, but I want to draw attention instead to this weird tactic you are using of only contrasting your theory with utilitarianism. "It is intrinsically good to keep your body intact" is a specific rule, "utilitarianism" is a specific theory. It is true that utilitarianism does not include this rule, but you can't defend this specific rule by contrasting it to one specific unpopular theory. Lots of non-utilitarians will also find this rule unpersuasive, you are setting yourself up for too easy a job by shrugging at disagreement and going "I guess the utilitarians are at it again". It's fine if you don't have some specific justification you can give, lots of people bottom out parts of morality in basic moral intuitions, but you should, in that case, admit that you are losing anyone who does not share your intuition, not merely anyone who is a utilitarian (and of course if you do have some more basic foundation, you should give that rather than just picking on the utilitarians).
The "strange moral rule"s you're talking about are usually things backed up strongly by moral intuitions. You know, those things that everyone recognises but that utilitarians seem to make a herculean effort to pretend don't exist. They're certainly not remotely arbitrary rules.
One may not share those moral intuitions for particular Rules, but they're invariably held far, far more widely than the intuitions for many of the things utilitarians advocate. Deontological theories at their worst tell you to rigidly follow a principle even if it's unnecessary, like suffering for charity or whatever. Utilitarianism at its worst literally tells you to execute innocent scapegoats to appease a mob.
That's just one of a half dozen crippling problems for utilitarianism (where it gives not just a non-moral answer, but the anti-moral answer). Another crippling problem: it's pretty clear, and all commenters agree, that you, Scott, did a really great, heroic thing. And you did. Yet under utilitarianism, you just did the bare minimum you're obligated to, and in fact fell far short of that if you're not living in a cardboard box and donating everything you don't literally need to survive. And you apparently don't deserve any praise at all.
The fact that commenters are praising you, while some of them also defend utilitarianism, only shows they're at the common stage where they either haven't noticed, or aren't yet willing to face, the contradictions in their religion.
You're greatly overestimating how many people here subscribe to the sort of pure utilitarianism you're describing. Plus Scott and anyone else who's read the sequences is unlikely to be that sort of utilitarian, by virtue of how the sequences focuses on the ways overly simplistic moral theories lead to abhorrent consequences if actually taken to their logical extremes.
>Deontological theories at their worst tell you to rigidly follow a principle even if it's unnecessary, like suffering for charity or whatever.
Do you seriously not know the basic textbook criticisms of deontology? Like how a universal prohibition on lying when put up against a tyrannical government, forces you to not lie about hiding dissidents in your basement?
1. I was a bit reluctant to turn a celebration of Scott doing a good deed into an argument about utilitarianism. But this is the first EA/utilitatianism-related post for a long time, so I'm doing that. I'm in awe of Scott's principled and compassionate greatness though.
2. I am just a bit sick of something in this community that may not be an actual motte-and-bailey, but functions a bit like one. When asked or challenged, most people here disavow utilitarianism in its pure or even substantial form. And then, when no one's challenging it, many of them fall back into talking as though it's obviously true, obviously uncontroversial, and then some indeed get very angry at the existence of people who criticise or oppose Effective Altruism. This part *is* a basic motte-and-bailey: when challenged EA is merely giving more effectively, when not challenged it's full-throated utilitarian dogma (at least for some people). It's also depressing when a charity discussion comes up and I think "finally something everyone can agree is good, and come together on", and then people start talking about giving to AI-risk or making the sigularity happen faster or some shit like that. Much like a Christian charity spending a bit on distributing food and a lot more on distributing bibles, or worse actually because the latter probably brings *some* benefit to real people who actually exist.
3. I find the "sequences" to be some of the most simplistic philosophy I've ever seen (among consciously attempted philosophical writing). I also find a lot of it's terribly written (bad and unclear argumentative structure, even occasional bad grammar). I can't for the life of me understand its popularity around here, but I guess that's a whole other discussion. I certainly can't see what substantive insight people get out of it
4. That objection is to Kantianism specifically, not deonology generally. The major advantage of deontological theories is there are so many of them (Kantian fairness-based theories, rights-based theories, contractualist theories), and each form itself is very flexible and debateable, allowing them be molded to actually fit common moral intuitions instead of violating them. The lying example is Kant's own interpretation of his theory, but it could be interpreted differently depending on how you understand the "maxim" you are following in that particular axe-murderer edge case, and to what cases it's precisely universalised.
In any case I'm not saying other moral theories don't have problems, but I think utilitarianism has far more of them, and they seem to be often ignored when not being directly challenged.
"I find the "sequences" to be some of the most simplistic philosophy I've ever seen (among consciously attempted philosophical writing)."
<mild snark>
For another contender, read Galt's speech in Ayn Rand's "Atlas Shrugged"
</mild snark>
> I find the "sequences" to be some of the most simplistic philosophy I've ever seen (among consciously attempted philosophical writing).
If you find mistakes, feel free to point them out. Simplicity itself is not a bad thing (unless it introduces errors).
> I can't for the life of me understand its popularity around here
Heh, I can't understand the popularity of Hegel's Logic, and yet. Different people have different preferences, I guess.
"If you find mistakes, feel free to point them out."
I plan to do so (to some extent) in an open thread at some point. It's a big discussion.
The "simplicity" I'm talking about is mostly the writing style, not the arguments. Really, I find that there mostly are no arguments, or at least not clear and explicit ones. Maybe I haven't read enough of it or I'm misremembering what I have read, but my impression is that it's generally either all-over-the-place rambling (leaving me thinking "what the hell are you trying to say? could you be so helpful as to write out your conclusion, and preferably your reasons too, in clear sentences?") or asserting as "obvious" significant and very much non-obvious philosophical claims about reality.*
But its popularity around here (especially among fans of such well-written, lucid and clearly argued writing as Scott's) makes me wonder if I'm missing something.
"Heh, I can't understand the popularity of Hegel's Logic, and yet. Different people have different preferences, I guess."
And most Continental Philosophy has the same problem: very rambling and unclearly written, and seemingly deliberately so. I think the 19th century German stuff (Hegel, Nietzsche) isn't *as* bad as the 20th century French, but on the whole both it and stuff by EY seem to have an ideological objection to clearly laying out their arguments.
*As a general example that I'm not sure was said by EY in so many words, but that comes across to me strongly in his writing: we obviously can't learn anything about reality by just thinking about it. Or, with a circular argument instead of no argument: the reason we know you can't learn about reality by thinking, is that if you're just thinking you're not testing your observations out in the world, and obviously that's the only way to learn about reality.
The reason we know empiricism is true, is that obviously empiricism is true.
It sounds like your perception of a motte and bailey is partly you lumping together people with very different levels of sophistication in their views.
I think the most serious rationalists who've put much thought into moral philosophy and read the sequences tend to be moral antirealists.
You're somewhat conflating between people who are just naive utilitarians who almost certainly haven't read the sequences, and people who view moral philosophy as primarily useful for guiding your moral views towards internal consistency.
Though people also often confuse things with very non standard conceptions of utilitarianism: like the idea that if you can rank the desirability of potential worlds in a non-circular manner then that constitutes a utility function.
>and then people start talking about giving to AI-risk or making the sigularity happen faster or some shit like that.
You're confusing moral philosophy with epistemology here. If you think AI is liable to change the world dramatically in one's own lifetime, then that will necessarily inform your behavior under any nearly any moral framework.
> And you apparently don't deserve any praise at all. The fact that commenters are praising you, while some of them also defend utilitarianism, only shows they're at the common stage where they either haven't noticed, or aren't yet willing to face, the contradictions in their religion.
On the contrary, you're the one who isn't quite grokking utilitarianism here. You're trying to graft a non-consequentialist account of moral desert to a consequentialist account of moral obligation: of course it's not going to make sense.
Utilitarianism does not say that only saints deserve praise; it has no special rules for issuing praise or blame at all. They're just ordinary actions, subject to the same imperative as any other. If the consequences of praising someone are good, do it. If they're not, don't.
Yes, that's my exact problem. It's blindingly clear to most people, as a matter of basic moral sense, that people who do good deserve praise and people who do evil deserve punishment. Utilitarianism says that if someone does a great deed, but by shaming them instead of praising them you could make them do even more good deeds, then shame them! And if someone horrifically murders ten people but you have good reason to think he won't murder anyone else, unless you anger him by punishing him, then let him go unpunished! Both of these are grossly offensive to what morality actually *is*, as we have a sense of it.
It also implies that among the people praising Scott, those who are utilitarians don't actually mean it and are just speaking strategically to manipulate others to act. Which is a nasty thought.
> Utilitarianism says that if someone does a great deed, but by shaming them instead of praising them you could make them do even more good deeds, then shame them! And if someone horrifically murders ten people but you have good reason to think he won't murder anyone else, unless you anger him by punishing him, then let him go unpunished!
Sure, naive utilitarianism.
But a proper discussion would include costs like 'it is often better to provide positive incentives' + 'being truthful is a good'.
... but also if the benefit was high enough, I would shame them. I don't have a hard rule that I won't do that. However shaming tends to generate a terrible culture that feeds on itself and/or self-flagellates enough to be damaging. It is also hard to evaluate whether that would really be better.
And for the murderer, you have the issue that you want to disincentivize murders. I'm pretty sure Scott has a post on this, but I failed to find it. If you strictly thought about the direct impacts of your choice, then if you let him go free then the murderer lives a decent life, but if you put him in prison then someone lives a bad life (ignoring that you imply he'd murder again). So you release him.
If you consistently follow this rule, then you've essentially given a Get Out of Jail Free card to anyone who can commit a bunch of murders (or other negative crimes), gets caught, and then can say they'll never do it again.
The proper analysis of this would be that you need to provide a disincentive. If you murder someone we throw you in jail. This makes so people are less likely to commit murder or stealing or whatever because they know they're likely to personally gain less from it.
This is similar to the analysis that some people give for the classic 'Doctor could save five lives by taking the organs of this one mostly-healthy person'. If you expect that an institution people can legibly trust (predict) to heal them and not do anything else would then help more people, than it is better than the alternative institution where you have to worry about getting your organs harvested and so you're less likely to go in because you broke your leg.
These do become deontology-like, but that's because I agree that deontology captures some ideas of our moral rules! However, I think that the utilitarian analysis lets you decide when it is reasonable to break them or shift them - if you do a proper analysis, which is hard! I see rules like 'Doctors will not harm their patients' as useful ways to be legibly trustworthy and reliable. The punishment of law is also about disincentivizing it from occurring in the first place.
As well, utilitarianism/consequentialism doesn't stop you from inherently wanting to punish others,
I don't really understand what you mean in that last paragraph. If some person praises Scott in order to manipulate (persuade) other people to do the same thing as Scott, what does it mean that this person might not "actually mean it"? If she is a utilitarian, she is doing that manipulation because she thinks that Scott did something that was a net good.
Do you mean that she needs to feel emotionally that Scott is to be praised, in addition to just calculating that donating a kidney is a net good? Like, she has to be emotionally sincere?
I've come to think I was too snarky and aggressive in the above comments, trying to simplistically refute utilitarianism, when other moral theories do indeed have problems too and there's a clear balancing act required. And utilitarians (especially those like Scott) are actually doing good in the world so who am I to oppose them?
What I do stand by is my point above that some utilitarians, including some commenters here, not only take it completely for granted but react with disbelief or worse that anyone could not be a utilitarian. I thnk *those* people specifically need to have all the many problems with utilitarianism shoved in their faces when they exhibit that attitude. But most probably aren't like that.
As for your question, I think what I was getting at was that if someone expresses praise for a deed, that should *necessarily* correlate with her thinking that deed was good. At least in theory, a utilitarian acts and speaks only to maximise good outcomes (not truth per se), and thus you can never be sure if she's speaking truthfully. But you make a good point that in the case of praise, the outcome and the truth are likely correlated. So my objection was perhaps not very coherent.
One hard case is whether you should let dictators have comfortable retirements or punish them if you can.
Maybe letting dictators have comfortable retirements will get more dictators to retire. Maybe punishing them will make them hang onto power as hard as they can. (Actually, no maybe for that one.)
But maybe punishing them discourages other people from becoming dictators.
I'm not sure consequences really apply here.
There are so few dictators and the circumstances under which any dictator comes to power and leaves power are so unique, and dictators by definition change or subvert the entire system including any precedents or previous incentives.
Also people who become dictators already know that they're risking death if they ever get deposed and know not to trust any promises of a comfortable retirement.
I am not sure I really follow. So you would deny LASIK, acl reconstruction, bariatric surgery?
All of these are not strictly necessary, so I expect your logic says you should not do them
Those are all procedures that restore normal phenotypic function.
I had LASIK to treat myopia, which was a phenotype caused by my genotype.
Genetics certainly play a role in obesity, and I wouldn't bet against genetic predispositions towards torn ACLs (or at least predispositions towards the foolhardy things we do to tear them).
I got evaluated for LASIK. (Sadly, I turned out not to be a good candidate.) LASIK pretty straightforwardly restores a normal function (seeing). It doesn't impinge on bodily integrity in the functional sense I have in mind.
Sure, it ablates tissue at the micro level. You can press that point if you like, but I'll consider it a kind of quibbling that doesn't interact with my actual position. Ditto with similar examples of medical repairs.
It seems to me that the principle you believe in is not really bodily integrity (because there are so many exceptions you accept), but something like "a person has an obligation not to damage his or her body's functioning".
Piercings, tattoos, circumcision, sterilization/vasectomy, hormonal contraception, abortion, breast implants/reconstruction, cosmetic surgery, sex reassignment surgery, anabolic steroids -- what is your opinion of these?
Does donating a kidney to a spouse or a relative also violate your principle?
Integrity and function are closely linked: removing an otherwise functioning organ is usually a sure way of impairing or destroying its function.
It's not really that I accept "exceptions" to damaging integrity as if they were special carve-outs. It's just that many such things are trivial (e.g., donating blood that will soon be renewed) or done precisely to restore function (e.g., LASIK or similar reparative procedures). I don't really view such things, properly understood, as "exceptions" at all.
I definitely disagree here. I share your view that bodily integrity has some intrinsic value, but I intuitively feel that LASIK violates that, which is why I would never get it.
LASIK is not so straighforward. It's a risky and experimental procedure, in that we still don't know the long-term effects of it. LASIK "restores function" (in some cases) by destroying tissue in ways that weaken the eye and the body as a whole, and there are just too many horror stories and too many risks for it to be justified.
In my view, this is not a coincidence or a flaw that can be corrected by a better procedure, but rather an inevitable effect of anything that harms bodily integrity.
You may well know more about LASIK than I do. If we have a difference here, I suspect it's about the facts of what LASIK does, not about the ethical principles to be applied.
Kidney donation restores someone else's normal phenotypic function. Does that count for anything?
So does a kidney transplant! Not saying that you should value other people's bodily integity as highly as your own, but presumably it should factor into your decisions if it is indeed something of value? I'm not saying anyone should do it, I'm still pondering it myself, but we come back to weighing up the loss to you (both definite and potential) against the gain to others.
If you don’t care whether others do it, and just regard organ donation as too risky/dangerous to consider for yourself, isn’t that just a matter of personal risk tolerance? Or would you advocate for shutting down voluntarily organ donation programs and the like, and enforcing strict restrictions on various surgical procedures?
I personally have very low risk tolerance for surgery (ex/ avoiding LASIK) but don’t think there’s a generalizable *moral* principle there.
So what *is* your justification for this belief?
The justification is that he doesn't want to donate his kidney but he also wants to continue feeling morally superior.
There's nothing terrible about not wanting to donate. I'm not planning on doing it. But trying to tear down people who do an obviously altruistic thing is very weak in my opinion.
No, that’s your hypothesis as to his actual motivation. Which may or may not be correct, but the principle of charity would seem to indicate that we should give him the chance to explain himself first.
Did you ever trip and cut your knee at school? Bye bye bodily integrity...
I have a fair bit of metal in my body from motorbike accidents and some polymers in my spine for other reasons.
Bodily integrity would seem to rule out even simple surgery or even something as crucial as the removal of a ruptured appendix.
We're a bio mechanical machine, parts are removable and hot swappable, within reason. I don't see any advantage to the pure state you are alluding to.
Neither deontology not utilitarianism would favour rules that are unenforceable.
"bodily integrity has a value in and of itself" sounds like something that would guide decision making without being a rule.
There's something very interesting going on with this section of the concept space. I can't quite puzzle it out. It's worthy of further consideration, but perhaps of a style better suited to Sam Kriss than Scott Alexander.
I agree. I find it interesting that there is good deal of psychological resistance to considering this possibility.
When it comes to morality, my experience has been that almost everyone including me decides what they think/feel is right, and then finds a rationalization. They know the answer they want to get before trying to think it through logically, and logic is then used to justify the felt-correct conclusion. If a particular logical argument is shown to have a hole, another will be found, but the conclusion won't change, unless it is shown that two moral values are in conflict. Before I was aware of this happening to me, it happened 100% of the time. Now I aim for a lower number, like 90% :)
Considering the idea that organ donation might be bad because of "bodily integrity" is going to be hard for people who have read Scott's post and decided that what he did was very good.
Similarly, I expect that you feel some negative feeling (I'm not you so I won't try to describe your internal feelings in detail) around some of your organs not being in you any more - it feels wrong for that to happen, and all your inside-bits being inside you seems straightforwardly right, and logical consideration of whether "bodily integrity" is a coherent concept on which to base a moral view is informed by the fact that yes, obviously your inside-bits should be inside you, that's not really up for debate.
I've tried to make logical arguments in favour of organ donation and against an overly restrictive definition of bodily integrity that would forbid it, while allowing a less restrictive definition so you can have your core intuition respected, but I don't expect that to like, work. :D
I don't feel negatively toward Scott or his decision on a personal level. I assume his decision was motivated by subjectively positive feelings, just as he mentions in the post. I see part of the value of norms being that they help guide decision-making independently of such feelings.
What "norm" are you advocating for here, exactly, and why? Based on what I've read you post here, I am genuinely unsure. It seems like different things in different places.
At first I thought it was something like "keep the bits of you together, and don't pierce your skin, although little cuts like a papercut are OK, and there are other exceptions which are obvious to me and I will be unimpressed if you bring them up" (if I was to put it in simple terms as best I can). But then you said something along the lines of "let your genes express themselves", and then "be like a normal human". The last two things seem to be getting further and further away from what I've heard anyone else call "bodily integrity", and to contradict each other if you have rare genes.
Feel free to disregard what I thought you meant and just say what you actually mean, and why you think the norm you are advocating for is good.
I agree with your basic premise, but would phrase it slightly differently. I think that moral facts are experienced by intuition and emotion.
We can try to come up with logical explanations, or theories, that try to take all these moral facts and explain them, but no one has ever done this in a satisfactory way.
So, no, your conclusion should not change because someone pokes a hole in the theory you make up to try to explain it. The conclusion is a moral fact - it is what needs to be explained, and if the theory is unsatisfactory or defective, you need a new theory to explain it.
Hmmm.... depending on what you mean by "moral facts", I may or may not agree that such things exist. I view the moral emotions such as guilt and moral outrage and the desire to punish offenders and reward good behaviour, as, well, emotions. Although certainly they're socially useful emotions which help us operate more effectively in groups, not just random things we feel. And the rules we make up when we operate in a social setting must take account of those emotions, because otherwise nobody will buy into the rules. But sometimes, moral reactions can cloud our thinking, and if we were thinking from a more dispassionate perspective about the situation, we might take actions that our future selves (who have gotten some distance from the situation we're reacting to) would think are better. For example, what seems clearly fair and right in an almost-factual "this is how reality is" sort of sense, right after you have been wronged, might seem unkind and unfairly harsh and unwilling to take into account factors outside of the wrongdoer's control, on future reflection.
To me, the basic idea "moral reactions are social emotions that benefited us in the ancestral environment" seems a satisfactory explanation for why our moral emotions, our felt-certainties about right and wrong, are what they are. And that way of viewing morality, something like Jonathan Haidt's Moral Foundaations theory, as opposed to the "everyone is given a conscience which is a moral compass built into us by a higher moral authority, and every sane and mentally intact person's conscience agrees on what is right and what is wrong" I was raised with, does a much better job of explaining the behaviour of the people I see around me.
With that said: On general principles, it seems bad to decide what the answer to a question is before you've applied your ability to reason, and then use your ability to reason to find post-hoc justifications that sound reasonable.
But _why_? Is it about outcomes? Sure, ”don’t do weird things to your body for no reason” could be a fine heuristic, but the whole point here is that there _is_ a reason. So that doesn’t seem to work.
But if it’s not about outcomes, what _is_ it. about? Aesthetics? Some unusual theory of value where your bodily integrity is _inherntly_ valuable but the life of a stranger isn’t? And how did you arrive at this highly unusual and ideosyncratic moral system?
Aesthetics maybe. So far as it being idiosyncratic I do note that Einstein declined life-saving surgery on the basis that it was 'distasteful'. I think he was 76 though so he may have felt he wasn't losing that much. But it does suggest that this style of objection is not necessarily super rare. Nonetheless, it seems mostly irrelevant ... we don't need to convince the 20% of people who have weird non-utilitarian objections, we just need to get 0.1% of people on board...
I don't find it unusual at all. He's expressing that there is value to integrity, not saying there is no value to the life of a stranger.
I suspect you are just exercising a value judgement. For example, you are probably against getting ears pierced, but have no problem with daily glucose checks for diabetics, which involve a finger prick. You can heal effectively immediately and with no distinguishable effects from a finger prick (not even a scar, very likely) so your "bodily integrity" is restored.
One has no need for ear lobes, but I can see feeling something missing, a lacuna to use Scott's (new to me) word, if one or both were removed.
If you feel this way, feel free to keep your organs. I don't see, however, how this should apply to others who don't currently have the visceral reaction you have. Why try to convince others of it?
What is a "basic genotypic design"?
If someone is born with a malformation of some sort, is a surgery that brings one closer to the median aesthetic appearance aligned with your rule? Because that person's "genotypic design", as far as I can make sense of the term, would be to have that malformation.
The very fact that you can identify something as a "malformation" indicates that you recognize a human norm from which it deviates. I'm talking about that human norm, which I do not put on an equal footing with the deviation.
But humans vary wildly. Leg extension surgery to extend height will bring you closer to the norm in The Netherlands, but further from the norm of pygmees.
So you do not care about the person's genotype, but instead about an idealized notion of an "ideal human form" which, in your view, all people should aspire to. Is that it?
I'm curious what the implication is of this remark - just pointing out something missing from what the post thinks through, or is the idea that this means that people should not donate kidneys?
This seems connected with Haidt's Purity or Sanctity values. I share the intution that bodily integrity has inherent value.
Just out of curiosity, did you have anything resembling a strong form of this belief before trans issues became a popular part o the culture war?
Or are you mostly back-filling from that?
My belief in this regard long predates the prominence of trans issues and is not significantly changed by them.
I'm kinda surprised they prescribed Tylenol instead of Ibuprofen honestly. Anybody know why they did? I had anaesthesia for a cortisone shot to help with postpartum osteitis pubis, so no painkillers really needed, but I can't remember the last time a doctor prescribed me Tylenol when I wasn't pregnant.
NSAIDs acutely decrease kidney function, and people immediately post kidney surgery don't have any to spare.
I always tell people that the single way in which my life has changed post-donation is that I now take acetaminophen instead of aspirin.
That's it. That's the whole list of things that changed about my life.
Hey Jeremiah, thanks for your podcast episode on donating. I shared with my wife, and we're discussing for me.
How do you feel about recent research suggesting acetaminophen may be little or no better than placebo? This is a serious question for me - I suffer from frequent mild migraines, and being able to pop an advil or two ~weekly is pretty big for my quality of life.
A couple thoughts, keeping in mind I am not a doctor:
My understanding is that having a couple advil a week wouldn't really be that harmful. If you were doing 4-6 advil per day for weeks/months on end, I think that would be bad. But in moderation it's probably fine?
Other than that I'm unsure about the acetaminophen/placebo stuff. It seems to work ok for me, but it could just be that I'm very placebo-y. I also am lucky to have never had any real medical issues, so I had nothing to really consider like that.
What I tell people a lot is that we don't need *everyone* to donate. If 1 in 1000 people donated, the kidney shortage would end overnight. If you seriously consider it, and conclude that it's not for you, then that's ok.
Also, ibuprofen is a mild blood thinner, and as such is probably not ideal for someone recovering from surgery.
I was hospitalized a few years back for a possible brain bleed (head injury with an ambiguous CT read), and I was specifically not given ibuprofen because of the blood thinning effects. Between that and having an intolerance to Vicodin (unknown whether of not this extends to other front-line opioids), they apparently decided that my only two painkiller options were Tylenol or Fentanyl.
Fortunately, IV Tylenol is magical. Apparently, you can get a much higher dose to your brain by bypassing first-pass metabolism in the liver.
>Fortunately, IV Tylenol is magical. Apparently, you can get a much higher dose to your brain by bypassing first-pass metabolism in the liver.
Yes, I'd imagine so. For most drugs you can simply compensate by taking more orally than you would IV, but if the liver gets too much paracetamol it breaks it down wrongly and kills itself, so that's a non-option (hence the warnings on all paracetamol packages to not do this). Hadn't actually considered it before, but it makes perfect sense.
It also gave my the idea of buying the oral dissolving powder form of Tylenol and taking it sublingually in hopes of getting similar effects. It isn't as dramatic as IV tylenol, but it does seem to kick in faster and work at least a little better than swallowing pills.
I'll be expanding my at-home medkit with that, thank you. I never knew that existed. It makes sense, just never crossed my mind.
It depends. Ibuprofen is routinely used for post-op pain where the surgical procedure is not associated with any specially elevated bleeding risk. Possible brain bleed is very much the opposite situation!
Reading about all these studies reminds me of this classic SSC post https://slatestarcodex.com/2017/08/29/my-irb-nightmare/ and the thought I had while reading it - why aren't there places that make medical research more frictionless in order to benefit (somehow) from everyone being incentivized to do their research there? You know, like the Delaware or Switzerland of medical research? Could some similar kind of clustering benefit organ donation as well as the attendant research? I'm sure there's a reason why this doesn't happen, but what is it?
Partly this is because most medical research is done with an eye to eventually pleasing regulators in a specific country, and those regulators want the studies to be done in their country by their rules. For example, to get a drug approved by the FDA, you need to show them studies done in America.
Some people advocate testing a drug in another country to see if it really works, and then, if it does, doing the study in the USA to please the FDA. The advantage there is that if it doesn't work, you can avoid the expensive US trial entirely.
But another reason is normal human and systematic limitations. If you are an ordinary medicine professor at (let's say) Harvard, and you want to know whether some heart thing you do in the hospital every day is beneficial or not, you probably don't have the money or capacity to get someone in China to study it on a Chinese population. You might just want to study the thing you're doing, in your own hospital, to see if it works, and then write the paper yourself.
To this topic, it’s worth checking this out when you have a minute and sufficient energy to get angry about the kafkaesque inefficiency of US clinical trials recruitment. https://open.substack.com/pub/bessstillman/p/please-be-dying-but-not-too-quickly
Participant population becomes an issue if you try to cluster like this.
I think if you had a population of a city where every non-rich citizen was participating in 5 different medical trials at once, because the city set favorable terms that brought every medical trial in teh world to their doorstep, that population would no longer be a meaningfully useful control group.
Why not?
Because someone who is on 4 experimental medications before entering your study is likely to have unusual readings at baseline and unusual reactions to your new medication.
My Goodness! I found this quite moving and overwhelming. Nothing but love for this man.
Even if one thought UCSF's screening criteria were reasonable, they sound badly out of order. If a history of childhood mental illness is potentially disqualifying in their eyes, they need to ask about that history very early in the process and not proceed with CT scans (for most), nuclear kidney scans, or even time-consuming and expensive investigations until they decide if that history is a dealbreaker for them. Asking a candidate donor to incur risk, meaningful expense, and/or serious inconvenience before addressing disqualifiers like this just isn't respectful.
I've been thinking about this. Their current method is "do all tests, including psych tests and radiologic tests", then "convene committee to see if any tests are disqualifying". You could imagine a two-step process, where they convene the committee once for the psych tests, then a second time after all tests. I'm nervous demanding this because I imagine it makes things more expensive and longer for everyone to catch a tiny number of people in this situation.
Perhaps they could develop a system where anything potentially disqualifying gets flagged before they continue the testing. At the testing level that could be a checklist, which isn't good, but then they could convene the committee or a smaller sub-committee to evaluate.
It really doesn't make sense for them or especially the donor to go through a bunch of other tests if they can tell that the person is going to be disqualified earlier.
Roughly speaking, shouldn't they be doing the potentially disqualifying tests in order of increasing "cost" per unit probability of being disqualified? ( By "cost", I'm pretending that medical risk (e.g. the ionizing radiation in a CAT scan), time, financial cost etc. can be scaled somehow and combined into one number per test.)
That's a reasonable concern, although the number of people disqualified for _any_ non-radiological reason after incurring risk, meaningful expense, and/or serious inconvenience might be more than tiny. And it shouldn't take a committee to tell the candidate that issue X could be a dealbreaker and what the program's general attitude toward issue X has been historically. Given the facts you presented, I doubt the UCSF committee's serious concerns could not have been reasonably anticipated by staff. I think my irreducible minimum would be informed consent -- the candidate needs to know that there is a strong possibility of rejection based on the information on file before incurring additional risk, meaningful expense, and/or serious inconvenience.
This certainly seems like it's scheduled for the benefit of the committee members, at the cost of the would-be donor, and the medical practitioners associated with the tests.
I think a "Coordinator" or a "Patient Representative" probably has more pull with the executive committee of the hospital than a doctor.,
If something as small as 'distant history of childhood OCD' is a disqualifier, then I'd imagine that it is NOT a tiny number being caught, and they absolutely need to do the psych evaluation first. About 20% of Americans have a mental health *diagnosis* let alone symptoms of a mental illness in the past that might be disqualifying. I have few friends that would pass that screening.
It can't be that consistent of a qualifier or it would probably eliminate the vast majority of EAs attempting to donate.
I'm saying that if this is the case at UCSF, then they absolutely need to do the psych eval first before making people go through the rest of the medical testing.
Ah, gotcha, yeah. It should be a first/early step rather than a last/late one.
This reinvigorated my desire to donate a kidney, thanks Scott.
Good luck!
I'm very happy for you, and completely unable to evaluate this rationally because a friend of mine died donating her kidney to her dying husband.
If you asked her in the afterlife, she'd probably be OK with the choice, but the incredible guilt that her husband felt afterwards is almost unimaginable.
Once again, I am being irrational and this should not dissuade anyone else; I merely was triggered to share my story.
I'm sorry to hear that. You're under no obligation to give details, but my model expected this to be pretty rare, so I'm interested in hearing any details you feel okay providing.
I never heard the exact nature of the complications, so I can simply relate that she was an extremely healthy ~50-year-old woman and she died on the table.
Yeah this is what I was thinking the whole time reading this article. Like, great, you have a bunch of studies and stuff (you know, the things that are constantly being dinged here for being full of fraud or just plain old incompetent) telling me that having my body cut open and removing an organ I'm using isn't a problem.
And I don't believe them. Sorry, but generally speaking if I have a thing, it's because it evolved to be there despite the costs of growing it (modulo the appendix?).
That's why people don't donate kidneys unless it's to their family. It's clearly risky. A bunch of discredited health people saying it's not risky isn't gonna change that - COVID showed clearly that they are the sort of people who will lie at the drop of a hat if they think it'll make people behave in ways that are somehow more "pro social" regardless of actual risk.
I agree with this. I've had supposedly 'low risk' surgery proposed for my own benefit and turned it down on the basis that I want an in-tact peritoneum without scar tissue, and that anesthesia itself is not entirely safe. I don't think the studies saying donating a kidney is fine make any sense, unless you consider maybe it's a selection effect - IE, anyone with any questionable medical issue at all is screened out first - so the comparison to the 'general' population is not a fair comparison. Really you would want long term randomized controlled studies comparing only perfect donation candidates who were assigned to undergo surgery or abstain. Anyway, it's a selfless thing you did, which is great, but I still think organ donation is an ethically tricky thing, and it's not clearly a slam dunk. I think it makes sense to really make sure the donors don't feel pressured in any way. It's not clear that having the option to donate makes all people better off.
> generally speaking if I have a thing, it's because it evolved to be there despite the costs of growing it
Epistemic status: I read this somewhere
One argument I find convincing is that kidneys and livers in particular were built for a more hostile environment than we currently live in (unless you're an alcoholic), and so have excess capacity. The acceptable age (at death) for donating a kidney or liver is higher than for lungs or heart, because they're under less strain.
TBC I'm not donating a kidney and don't expect anyone else to, especially for free. But I think this particular argument is weaker than it looks.
Isn't the appendix now thought to be a reservoir of your intestinal microbiome to facilitate rapid repopulation of your gut after an event (e.g., infection, poisoning) that causes the system to be flushed out?
Congratulations Scott! I became a non-directed donor 14 years ago. I was inspired by a New Yorker article by Larissa MacFarquhar, you may decide whether that's better or worse than Vox.
In addition to the very obvious benefits to the recipient, who is still doing well, I think donating helped me solidify my adult identity. Not in any public way, no one in my current city of residence even knows except my wife and whoever has read my medical file. My experience is that much as the rite of circumcision is meant to bind us Talmud-readers to God, kidney donation binds one to principles of altruism in a way no amount of donated money ever will. Even as I've gotten older and less idealistic, I remind myself that I am a man who once donated a kidney, that I should never let my character stray too far from that of the younger man who was capable of such things. No regrets.
I find that very compelling and inspiring. Thank you for sharing it.
That will also prevent you from reevaluating and changing your mind, if you were wrong, though.
While you might change your mind about what exactly constitutes moral goodness, it's good to have a reminder to strive for moral goodness as you understand it.
>a ritual called “therapy” could absolve one of this impurity
When I read this section, I had the following thoughts in rapid succession:
- As a psychiatrist yourself, you are qualified to perform therapy. And you do mention that OCD is one of the conditions you treat in your patients.
- So could you do therapy on yourself? It would certainly be simpler and more convenient than going to a non-self therapist. Probably not as effective if you actually had an active problem you needed help with, but it seems more than adequate for an exercise in warding off evil spirits.
- Autotherapy could defensibly be described as "talking to yourself", which put that way is usually considered a sign of not being sane.
- So for mental health professionals who are qualified to perform therapy, does talking to yourself make you more sane, less sane, or have no net effect?
There is a minor psychoanalytic tradition of "autoanalysis" or "self-analysis" but I don't think it gained that much support from most theorists, although it seems like it's not particularly impossible that it could be very helpful to some people. (After all, apparently you can make pretty consequential changes in your own mind in other ways, like meditation practices.)
I kind of doubt that the panel would have accepted anything like "I promise to perform therapy on myself to treat my OCD, if necessary" or "I promise that, as a psychiatrist, I would not currently diagnose myself with OCD". :-(
The effectiveness of autotherapy would heavily depend on the approach--anyone can do a workbook on their own, for example. Some people, professionals and lay, have a lot of discipline and insight and can do this kind of thing very well independently. But not all people, and not for all problems. In some approaches the relationship with the therapist is a functional part of the technique, which can't be replicated alone. Being a mental health professional likely aids a personal quest for better mental health but the physician cannot always heal thyself. In medicine self-practice is at best frowned upon and at worst disallowed, for reasons that also apply to autotherapy. It's difficult to be objective, it's easy to take advantages that hurt you in the long run.
Talking to yourself is not inherently pathological. While "taking to yourself" conures up an image of someone walking around in public muttering to the voices in their head (and that's obviously not a good sign when it does occur) most self-talk is just a way of augmenting thought, with no ill implications.
(Sorry, I know it's kind of a joke, I can't help myself sometimes.)
I think if you switch chairs during a self therapy session that implies a degree of objectivity 🤓
Ah, that would be the Tim-Curry-in-Clue school of psychology.
> Autotherapy could defensibly be described as "talking to yourself", which put that way is usually considered a sign of not being sane.
By who? Talking to yourself is something everyone does all the time. It's widely depicted in popular TV shows as being completely normal behavior. (And in this case, the TV shows are correct.)
I'm being facetious. The joke is that "talking to yourself" in the literal sense is a common and usually harmless and occasionally beneficial behavior, but the same phrase is also often used as a shorthand for specific behaviors symptomatic of schizophrenia: either disordered ramblings directed at nobody in particular or conversations held where the other party is the product of delusions.
On reading that Scott was turned down for kidney donation on account of having had mild OCD in the past, my first thought was amazement that something apparently so unrelated could be a factor in their decision. He may as well have been rejected for once having an ingrowing toenail!
is it minor?
i think people are assuming it was because it would harm
the recipient, but id wager they also consider the long term mental effects to the donor. Whether or not it might harm their mental state.
Or that it cast doubt on his state of mind in volunteering to donate (i.e., he could have been feeling compelled to donate rather than choosing freely).
yes the donor is going through an irreversible choice. State of mind should be ironclad.
I don't think so, since the OCD points to the possibility that it may be obsessive thoughts causing him to need to donate.
Could you not also attend a Zen retreat for ten days of non-Self therapy?
That would be a Theravada therapy session. Zen would be a "True Self" therapy session.
Enjoyed both your and Jon's comments. Brought a smile to my day. Thanks!
Another thing, hasn’t he had therapy since the diagnosis already, why doesn’t that count?
What was the radiation risk from a "nuclear kidney scan"?
Almost zero, surprisingly!
It's amazing how much radiation dose you get from a CT.
https://xkcd.com/radiation/
I guess the issue is that the radioactive dye in the scan is very specifically absorbed by the kidneys (whereas the CT is just kind of "throwing X-rays at all the tissue and seeing what bounces off"), and also that the nuclear kidney scan is essentially 2-D while the CT is 3-D?
According to
https://www.ncbi.nlm.nih.gov/books/NBK562236/
the dose from the nuclear kidney scan can be on the order of 1/10 that of a CT scan, so it might not be appropriate to think of it as totally negligible, unless they're talking about a slightly different procedure.
The radiation cancer risk argument is just wrong. This is from modelling studies not from prospective or retrospective studies. After 127 years of X-ray use there is not one study in adults that has shown increased risk. The low no-threshold LNT theory makes no sense and even if it were true it should be proven in a longitudinal studies.
Radiologists and others who work with radiation despite protection would have increased risk of cancer because there is always some radiation absorbed. There has been no extra risk reported except in the early days when they did not understand risk of high doses.
X-rays are 1/300th the radiation level we're talking about here, so not comparable. I don't think anyone has been irradiated by CT scans enough to empirically discredit LNT, but I'm interested in seeing any studies you might have available.
I like Jack Devanney (a Thorcon molten salt reactor founder I believe) on LNT
In "Circling the LNT Wagons" he analyses a slightly positive LNT study noting that:
"They excluded the data they had already collected from 12 of the 15 countries because ``of the limited resources and consequent need for efficiency in project coordination." The three countries that survived this project coordination process were France, UK, and the USA. The three countries selected just happened to be the only three countries in the 15 that had nuclear weapons programs."
-https://jackdevanney.substack.com/p/circling-the-lnt-wagons
Nuclear weapons workers are more likely to have received acute doses. Based on Devanney's posts it seems really likely that LNT is either non-existent or non-provable below about 20 mSv acute doses
This is interesting in this case because you are talking about a 30 mSv acute dose. While LNT is likely to notably overestimate the risk at this level it is reasonable to think an elevated risk exists. Interestingly, one of Devanney's critics in his comments does not defend LNT but does argue that acute medical doses have a slight cancer causing effect. For most things it is again potentially unmeasurable but 30 mSv might be in the measurable range
In his "The LNT-is-not-inconsistent-with-the-data Argument" post Jack has a graphic of about 30 dose profile cohorts that are prominent in the literature and history. The only ones comparable to 30 mSv acute seem to be the nuclear bomb survivors:
14,000 with 5-20 mSv acute dose showed an insignificant decrease in solid cancers
6,000 with 20-40 mSv showed the same as control
11,000 with 40 - 125 mSv showed an insignificant increase
16,000 with 125+ mSv showed a significant increase
Leukemia numbers were similar except the insignificant decrease group was from 5-150 mSv
- https://jackdevanney.substack.com/p/the-lnt-is-not-inconsistent-with
We've also done a lot of experiments in fruit flies to demonstrate that radiation effects on health are non-linear in them as well. But nobody knows where they start to go non-linear in humans and the dreaded bioethicists would surely prevent any good experiments determining that. So in the absence of good data we must make do with the simple rule we know is wrong for legal limits etc.
I've wished I could do this for years, but thanks to a life-saving, kidney-wrecking medication I'll be on in perpetuity both of my kidneys will be needed by me. I saw the headline "my left kidney," correctly guessed the topic, and immediately started sputtering about my own bad luck. Congratulations Scott, I am happy for you, your donor, and to see this issue publicized in a forum where I'm sure it'll get traction. Happy, and a little jealous.
Of course now I'm sitting here stewing on whether I'm a really a 200-in-a-few-hundred-millioner who would really go through with it or just a 25%-er with a fond intent and a pat excuse. It does feel like the easy, obviously correct choice--a life you can save that will be practically right in front of you--but now I'm very suspicious of this little fantasy and the role it plays in my psyche, with no skin (er, organ) in the game...
(If anyone else is worried they just have a hero complex and their heart isn't entirely in the right place, don't let that deter you from putting your kidney in another one. We all appraise ourselves in creative ways.)
How do they(or can you decide?) choose which kidney they take from you?
Unless tests reveal some unusual asymmetry, they take whichever one has longer blood vessels that are easier to manipulate surgically, which is almost always the left.
How does it feel knowing that your evil kidney is likely now directing some poor stranger to turn to the dark side? The writer that you are, that kidney may be too persuasive for them to resist...
https://en.wikipedia.org/wiki/Body_Parts_(film)
My immediate reaction to the apparent mystery of : "25-50% of Americans say they *would* donate a kidney to somebody in need..."
I think those 25-50% are thinking of a scenario somewhere in between
-rushing to pull people out of a sudden immediate fiery car crash right in front of them
- donating or volunteering in a natural disaster
- John Cleese showing up at their door asking, "Could we have your kidney, then? Won't be much trouble for you."
When the choice or opportunity is suddenly presented, and following through is relatively simple, logistically, people and Americans in particular have almost no limits or thought of risk/cost. In the scenario of a crash/wreck I am sure 95% of people would risk their life for a total stranger without a moment's thought.
The barrier to high leverage humanitarian intervention is not courage or selfishness but attention span. Even you, a person who thinks and cares about doing good, who inspires others to likewise try to improve the world, and an MD with major cheat codes for Health Care and Medical melee combat, you were discouraged and almost gave up. Until a Mysterious Mentor suggested a Surprise Approach, One Weird Trick of trying another donation pathway, tvtropes etc.
Leaders can be described as getting people to do good stuff they should do anyway. Personally, I always tell people that when thry ask somebody for a favor, make it *AS EASY AS POSSIBLE* for that person to help you. The path to better more effective Altruism, and government as well, should keep those things in mind.
BRetty
Sounds like we need to recruit a corps of door-to-door proselytizers, then, and maybe lock a bunch of bioethicists and con artists in a room together, unable to escape except by agreeing on details of a training program for professional kidney-donation-facilitators which somehow threads the needle of making the process easy enough to actually complete for people who should be donating, without misinforming or coercing people who shouldn't.
As it stands, nobody goes through the process from the donor side enough times to become an expert on it, and the skill-set of making things easier for a customer is valuable enough to be in demand elsewhere.
"maybe lock a bunch of bioethicists and con artists in a room together"
I love that image! Many Thanks!
You are exactly right... there is nothing like a donor-side "facilitator" and each donor navigates the process exactly once. Good insight. B
Could just lock all the bioethicists in a room, throw away the key, and try to reassure people that they around to hurt you anymore, you can do medicine now!
Congratulations!
> And it encourages people to be masochists,
And sadists! Suffering is a sign of virtue, so therefore by making people suffer one can increase the amount of virtue in the world. Just look at all those stories of people who went through adversity and came out better. Who wouldn't want to have moral justification? Any reluctance on their part is simply akrasia. (Or at least, that's what my PTSD says.)
> Would, if what?
Quite possibly, if my life were more together. But thanks for writing all this.
Just find a nearby munch.
I am duly impressed.
My one friend who did this feels like it was the most significant event in his life. And he has lived a very full life.
I've been torn about the prospect of donating a kidney for over fifteen years. On the one hand, I see it as a really worthy form of altruism, and I recognize that in absolute terms the risks are quite small. On the other hand, I'm quite vulnerable to anxious intrusive thoughts, and the anxiety of having only one kidney, when evolution saw fit to equip me with a spare, feels like the sort of thing which would genuinely weigh on my sense of well-being for the rest of my life.
Do you think you might be open to a literature dive on the pros and cons of donating regenerable organs and tissues, like liver or bone marrow?
Maybe!
Anxious intrusive thoughts about only having one organ were a concern for me too. I tried telling myself I would do some healthy things (stop adding salt to food, go to the doctor more often) that would probably make up for it, and that sort of helped. So far I haven't felt too anxious-intrusive-thought about it, but partly that's because I'm still in the more acute kidney failure stage of recovery where I'm expected to feel bad, and I don't really know what the future will bring there. Ask me in a year.
Cutting salt indefinitely sounds more masochistic to me than a one-time surgery!
Scott has written before about not really being a fan of food in the sense that a lot of people are, and I suspect there's a general trend of this kind of underrating general experiences (even coming from the guy that wrote "what universal experiences are you missing.")
I know there's a renal diet for people with kidney disease/on dialysis (mainly be very careful with potassium and if you eat potatoes, you have to twice-boil them which reduces them to a mush that is difficult to eat so you may as well cut them out altogether).
Seems there is a diet for kidney donors; moderate protein, reduce salt intake, be careful with supplements:
https://www.ohsu.edu/sites/default/files/2019-06/Healthy%20Eating%20After%20Kidney%20Donation%2004-25-2019.pdf
https://www.jrnjournal.org/article/S1051-2276(13)00211-2/fulltext
I looked into liver donation after getting denied for kidney donation and the risk is way, way the fuck higher. Something like 1% fatality risk in the immediate aftermath. I was comfortable accepting "twelve hour drive" risks to save somebody's, or multiple somebody's, lives, but not "die at any point in the next year or two" risks. If you do survive without issues, your liver returns to full function.
Do you have some sources to check out on this?
No, it was a while back, I just used Google Scholar and whatnot to look into it.
There is literature suggesting that missing-spare-kidney intrusive thoughts are a real risk, which is why they reject people with OCD. So 1) maybe kidney donation isn't right for you, and 2) if you decide to do it, you probably don't want to disclose your concern to your donation team. Like Scott, I was rejected for mild OCD, and I really wish I hadn't been so honest in the psych eval.
I personally think it's not for me, because it's not just that I'm generically prone to anxious intrusive thoughts, there are specific things that cause me anxiety which aren't necessarily intuitive to other people, but I find predictable in advance. For instance, I have no problem engaging in martial arts sparring, but I refuse to ski- I can't help envisioning myself rolling down a ski slope with a ski pole stuck into my eye. I can forcibly fight down anxieties which I know are irrational, but it doesn't make me comfortable, and I don't want to spend the rest of my life doing it.
Conversely, some things that other people worry about don't bother me at all. I'm not paranoid about the dangers of a routine surgery, for instance, or low-level radiation exposure. I'd be happy to be able to bring my kidney-anxiety down to a level where it's proportionate to my other worries, but I don't think I'm actually able to do that.
Yeah, sounds like it - and I hope you don't concern yourself over the question "should I donate or not." You have a contraindication and it isn't reasonable to sacrifice your own well-being.
I get how anxieties can be different, but predictable to those who have lived them. My anxieties are around ethics, i.e. am I doing right by others; if others aren't doing right by me why doesn't anyone else notice and does it mean there is really something wrong with me. And I can be OCD about the uptime and quality of software systems I build. Besides that, I don't have much in the way of intrusive thoughts - which is why I was pretty confident I wouldn't experience the without-spare-kidney anxiety.
Yeah, the anxiety caused by the risk of dying later on due to donating would make me significantly worse off. Imagine how crappy you'd feel if you died because of that! You'd feel so stupid and like such a sucker! "If only I hadn't donated," you'd think. Anything would be better than having that kind of regret and fear your whole life!
As an aside, I'm surprised that you read Scott's piece and concluded "the risks are quite small" - I found this article scary.
I did some sort of thing where I gave my dna via cotton swab to some charity and said email or call me if anyone needs something I’ve got. It seemed legit, but no one has ever contacted me. And I assume my superior Slavic-Irish-Norwegian ancestry would greatly enhance a normal mortal life.
Asking because I suppose this group would know: Is that in fact a real thing? Or did I give my DNA to skynet? I swear I got it from a flier at a hospital.
I think that's probably about bone marrow?
Maybe they don't actually share DNA information about different kinds of prospective tissue donations? (which I guess would be kind of wasteful, if not)
You’re right. I found the little cards they emailed me in my desk. And here I thought I was open like s buffet.
Open for what?
For people needing spare parts.
As Seth said, bone marrow data bases work like this. For a bone marrow transplantation, you have to screen millions of people to find a match. So they build huge databases (for example 7 millions just in Germany, ~10% of the population), and only contact you if you are a match for someone in need. The chance of ever being contacted is less than 1%, but the system only works because of the huge DNA databases.
I did this for my local bone marrow bank. They contacted me a decade later and told me there is a potential match, but never reached out again, I presume they found a better match.
real thing, I've commented about what it's like (or look up Anthony Nolan, the charity that does that stuff in at least the UK)
Scott, have you thought about meeting the person who got your kidney? Of course it might be awkward, meeting a stranger whose life you saved, and you two may be so different that you're each incapable of comprehending the other's take on life. And yet you had a meeting of the minds and kidneys when it comes to saving the person's life. I'd want to shake their hand or hug them and say, "I hope that kidney makes possible all kinds of wonderful things in your life" -- or something like that. Maybe just "enjoy the hell out of that kidney."
There's something about direct giving to strangers that feels utterly different from EA. It's profoundly satisfying, and makes you want to give *more.*. Maybe the way to think of it is as a spiritual practice, one that people practicing EA need to do to stay in touch with the point of helping others?
Anyhow, bless you, Scott. And if it would make you feel any better about the Uber incident, I'd be willing to piss myself in an Uber for you.
I took the liberty of looking up Scott's recipient. He's a real stickler on an IRB and eats an all-meat diet.
Yeah, I looked him up too. You'd think a writer for the New York Times would have been trickier to track down, sheesh!
But why be sure they'd loathe each other even under ordinary circumstances? Scott himself could be called a real stickler by some, and they'd have a point. In the most recent open thread I showed some people Scott's kind-true-necessary, 2 out of 3, guidelines, and the people had a low opinion of them -- saw them as suppressing free speech, suppressing justifiable expressions of rage at various actors in the Palestinian-Isaeli situation, so vague that any judgment could be defended, etc etc. And is what people eat really such a big deal? Anyhow, even if Scott and Stickler would have loathed each other in other circumstances, having a moment of intense shared emotion is all the more special then. And I'm guessing that even most meat-eating sticklers aren't so hard-boiled that they are not moved by someone having saved their life.
That objection to me sounds like ignoring or not noticing how a 2 out of 3 rule actually works.
But also, the rule is designed for the moderated comments of one persons blog, not a general public space.
There is no perfect system for moderating a space like this, but I think Scott's works well in practice, and I'm happy with it.
Where do you look such things up?
Almost certain both of those people were joking, implying Scott's Kidney went to someone he wouldn't like and who makes the world worse, in a sort of "accidentally saving baby Hitler" scenario.
There's probably no way *you* could look up Scott's Kidney recipient, for medical privacy reasons (Scott might be able to, not sure).
Oh -- duh, of course.
Dudewheresmykidney.net
i think in some cases you are allowed some contact with the kidney recipient via email, but it has to be completely anonymous and is reviewed by censors before being forwarded on.
Yes, that might be. Seems pretty micromanagerial to me, sort of like the bureaucracy that would not let Scott be a donor because he's had mild OCD as an adolescent. I have seen articles about people who donated a relative's heart meeting the person who received the heart. Donors meeting recipients seems like on the whole likely to be a very positive experience if both parties would like to do it.
Seems very disturbing. What if you didn't like the person? Here you made a significant sacrifice, giving up your health, and it was for this person?
And what about the power, obligation, control, and guilt issues? They meet you, and they feel like they owe you something, or you feel like you owe them something ... really disturbing. Seems like it would be hard to relate to them as normal humans with such a huge debt there.
You'd always resent them for having one of YOUR organs that belongs in YOUR body! You'd get angry every time they did something you didn't like, or disagreed with you, since they basically owe you everything! Just an unhealthy relationship.
I'm sure many donors and recipients would not want to meet. But there are all kinds of ways a meeting like that can play out. The ones you imagine are only a subset of the possibles. Some people's take on the process may be one that protects them pretty well from going down these grim paths. If had donated a kidney I think I would want to meet the recipient. I'd have assumed when I donated that the organ would be going to someone who does not share my attitudes, beliefs, politics, taste, etc. After all, most people don't. I think my feeling of connection with the unknown person who was going to get my kidney would have been that, like me, they want to stay alive, keep seeing the people they care about, keep doing the things they enjoy. Part of the specialness of charitable giving is that you are letting go of all your angry stuff about the many many groups of people who believe and do things you think are pointless or evil -- at least letting go of it to the extent that you believe they do not deserve to suffer. So if when I met the recipient they were wearing a campaign button for some candidate I didn't like, that wouldn't matter. And I don't picture having a big get-to-know you meeting with them -- just talking over the thing we have in common -- the experience, how we're each doing, and wishing each other well.
As for their gratitude -- of course they have to say thank you. Etiquette sort of demands it. But I would try to get across to them that "thank you" doesn't exactly apply in this situation. If I had chosen them as my recipient thank yous would be in order, but I didn't. I gave the kidney to humanity at large. It was luck that sent the kidney to them in particular. So I would tell them that, and tell them that giving it had given me a lot of pleasure, in fact made me sort of high, so in my own way I had benefitted greatly from the experience. Maybe add something about how I I gave the kidney to humanity at large -- if they feel they owe a debt, they can work it off by giving something to humanity.
So there's a 1 in 10,000 chance of dying during the actual surgery, but there's a 1-2% chance that you'll develop kidney disease later on in your remaining kidney and think "boy, I sure wish I still had that extra kidney right now". BUT, you'll be put at the top of the list for the next kidney. BUT, kidney recipients typically only live an extra 5-7 years anyway. BUT, under these kidney disease circumstances you might not have been okay with a second kidney anyway. Nonetheless, your chances of dying due to kidney donation seem to be higher than 1/10,000 due to the whole lack of redundancy thing, probably very much greater than the 1/660 risk you were concerned about.
"Dying" isn't a very good binary variable. I think there's a 2% chance you'll die six months earlier than you would have otherwise, but multiply that out and it loses you 1.2 days of life. Dying during the surgery seemed important to me because it loses you a lot of life as opposed to shaving off the very end when you have no GFR left anyway.
Doing this properly would involve how many DALYS you expect to lose. I think I looked at someone's calculation and it was in the range of a few weeks, probably so much that the variation in length of your recovery period is bigger than the amount contributed by early death or early disability considerations. I think the Tom Ash post I linked might have those numbers on it, although I might be misremembering.
Okay but this is all "present rate no singularity", yeah? If you have a reasonably high probability of a good singularity, then dying a couple of years early in the coming decade might lose you many, many more highly enjoyable years than a naive approximation would suggest.
(IIRC from your old cryonics post you don't care *that* much about your mortality as distinct from suffering? Which, fair enough. But I would assume that most people worried about life expectancy post-surgery are not like this, so it feels worth mentioning.)
Even if there's no singularity, it's reasonable to expect medical care to improve.
the “UCSF lost to waking up in an ice bath” chart is absolute gold. Hadn’t laughed so hard this entire week. Who said this community can’t do humor?
The bit about how you can get five other people get bumped to the top of the list if they ever need it is a REALLY convincing point. I didn't know that: I heard about how you personally get bumped up the list, but that's the bare minimum, not a good deal.
Worth noting that this is not very gamable, and they make it really clear that the set of you share a priority-claim on up to 1 kidney. From the look of things, once someone uses it, the others do not have the priority mark anymore.
Thanks for pointing this out. Then it's a non-obvious tradeoff between a larger list of people you care about to whose kidneys yours are compatible, and a smaller list (five people) which could include incompatible people. That's … decidedly less convincing now.
Not sure if this untangles the non-convincingness, but from what I understand, you can "donate a kidney to a loved one" even if you're non-compatible. What happens is that you donate your kidney to a compatible stranger and in return they ensure a compatible stranger in a symmetrical situation donates their kidney to your loved one. I think this is commonly the way it works.
This is interesting, and I wonder if you can change the names later on. I'm thinking about the sorts of incentives this could create.
I suppose "Inside you there are two kidneys" is more accurate than having wolves
Two wolf-shaped kidneys?
Re the people who say they would donate a kidney to help a stranger:
I think most people answering the survey question are imagining a case where they're uniquely morally responsible for it in some way, in which case they'd do it.
Going by your numbers, the actual number of undirected kidney donations required to plug the gap is about 0.01% of people per year. So IRL people are probably morally responsible for about 0.01% of a kidney donation per year (probably more in practice because some people can't or wouldn't donate, let's say 0.04% for safety), and going beyond that is superegatory.
I'm on the list of people who'd answer "no" on the kidney donation question (I do feel bad about it). But I would sign up for the service that picks 0.04% of people who sign up at random each year to donate, if it solved the kidney shortage. I wonder how universal this is.
(This does raise the question of why I don't just make my own service by throwing a random number generator from 1 to 10,000 and donating if I get under 4. I did do this before posting and got 5,143, so that's my new excuse for not donating. But I don't know if j would have gone through with it if I actually had gotten a number under 4, so I don't feel great about it).
I got 7127, so I suppose I am also excused!
Your comment got me thinking - I would probably also sign up for such a list, if it existed and - I think this is important - if a lot of other people also signed up, so that my odds of donating were "fair".
But then it occured to me that something similar already happened in the UK. A few years ago we switched from opt-in organ donation to opt-out. Essentially that means that if you die, you are now assumed to consent to organ donation unless you explicitly said you don't consent.
In a way that is similar to drawing lots, since we can assume I have some chance of dying randomly in the next year and some chance that my organs are suitable for donation. I am not sure that enough people die in the right way to fill the gap, but I suppose it should do something (especially as each suitable person would be able to donate both their now unused kidneys, plus other organs like hearts, lungs and livers).
Unfortunately I can't find much saying it has really had an effect. Partly that seems to be because it was introduced just before covid, which has muddied the numbers. In essence, though, the number of people on organ waiting lists seems to be pretty much unchanged or even slightly higher.
The difference between opt-in and opt-out is notable, but does not change the order of magnitude, unfortunately. Looking at different countries who changed one way or the other, the number of donations may increase by 30-40%. (Less if relatives still have veto rights, which they do in some countries.)
In practice, most donors are young people who die in accidents, like bikers. Most of them haven't declared their will, so usually relatives are asked to find out their will. In most countries it boils down more or less to the same decision for the relatives, regardless whether it's opt-in or opt-out.
30% more makes a difference! The supply is not THAT much smaller than demand. But it is still not enough to get enough organs. The number of people whose organs can be used (who die young from accidents) is just small, and the number of people who would need organs is pretty high.
A thorough literature review with in-depth discussion for Italy, France, Wales, Greece, Chile and Singapur is here (in German, so you need an auto-translator)
https://www.bag.admin.ch/dam/bag/de/dokumente/biomed/transplantationsmedizin/literaturbeurteilung-einfluss-von-zustimmungsmodellen-spenderegistern-und-angeh%C3%B6rigen-entscheid-auf-Organspenden.pdf.download.pdf/Literaturbeurteilung-Zustimmungsmodelle-Organspende.pdf
I am also on the list of people who'd answer "no". But on the other hand, I did register for bone marrow transplantation. There they screen huge databases for the best match, and you are only contacted if you are a best mathc. Which happens for less than 1% of registered potential donors.
This system works very well. If you are contacted and told that they particularly need your bone marrow because there is this one person who needs it, then I do believe that many people would say yes. Perhaps the 25-50% who answer yes in the surveys.
In principle, this could also work for kidneys. Build a huge data base, for each patient try to find the best donor, and ask them whether they would help this particular patient, because their help would work better than anyone else's.
It's almost a shame that kidneys are compatible between so many different people. Because that might be the main reason why the solution doesn't work. (Even if chosen, you are not really a much better pick than many other people.) So the ethical pressure is diluted. We might have much less trouble to find kidney donors if they weren't so widely compatible.
Or the solution does work, and we just need to try it.
Agreed. "There they screen huge databases for the best match, and you are only contacted if you are a best mathc." Also, there is (or was? this was over a decade ago) a secondary screening where they take another sample and check more antigens. I was contacted as a potential marrow donor at least twice (I forget if there was a third time), and I think I was the most probable donor at least one of those times, but they never actually took my marrow. I don't know exactly what happened to prevent it. ( I've aged out of the registry at this point. )
Interesting. I have no idea what was going on for you.
Funnily, I was chosen by them, too... as statistical twin to a real donor. That's why I never forgot about it, I get a form once a year to tell them if I am still healthy.
I have the vague recollection that something had changed on the recipient's end, but I wasn't told whether it was positive or negative (which is perfectly reasonable for their privacy). I too got a contact once a year (till I aged out of the registry) asking if I was still willing and able to donate.
Hey, I know I'm coming to this super late, but this comment inspired me to write up my experience getting matched from the bone marrow donor registry and donating blood stem cells: https://forum.effectivealtruism.org/posts/69kYhMjGnvgHqHP9r/my-experience-donating-blood-stem-cells-or-why-you-should
Overall, it was a very positive experience and I would recommend that folks sign up for the registry if they can (for the US, it's "Be The Match"; for the UK it's "Anthony Nolan")
Hey Silas, thank you very much for taking the courage of writing your experience down! I was always a bit nervous about whether I would really say Yes if I was ever matched. But after reading your post, I am now a lot more confident that I would go through the whole process. As you say, reading about personal experience adds a lot to all the statistics which say you'll be fine. Thank you for sharing!
That's wonderful to hear, thank you :)
You might've stumbled on a back door way to financially compensate kidney donation (in expectation): it's probably not illegal to pay people to sign up for such a service as long as they have the ability to back out if selected. Conditioning the payment on passing screening could do multiple duty of (a) weeding out low-intent volunteers, (b) keeping the average quality-as-a-donor on the list high, and (c) enabling payments amounts large enough to actually incentivize sign ups.
Sort of like reverse insurance?
I suppose it is 🤔
How old is too old to do this? (As in, at what age will they refuse to take your kidney?)
I don't think there is an official age, and it probably depends on your health, but I think being older than 50 probably changes the risk calculus to a point where I would be reluctant to do it, though this is just a gut feeling and I haven't looked into it too hard.
Yeah, I guess I was wondering if this is a good way to effectively buy kidney insurance for the family. I think it might be.
Was there really a need to tell the whole world about the good deed you have done? Performing good deeds for social affirmation is generally considered to detract from the goodness of the deeds. Yes, I do understand that your intent is to encourage more performance of such deeds. But conventionally, performing good deeds for external rewards like social approval or money is considered suspicious, for some poor reasons (like the masochism you mention) but also the tendency toward self-deception and institutional corruption by those rewards.
This directly ties into the castle thing. Perhaps it's true that the castle actually would encourage more good deeds be done. However, it's also true that if you start talking yourself into buying comfy castles that actually do good, it becomes easier to talk or trick yourself into comfy things that don't do good, and you start to attract people into your organisation who will talk you into buying comfy things because they are solely into comfy and not good deeds at all. We can try to be less wrong here, but can we be sufficiently less wrong that this risk is worth running?
Yup!
Edit: the "Yup!" applies only to your question at the end; I disagree with the general thrust of what you're saying.
I think yes, for a few reasons:
1. If you tell other people about your good deeds, you feel good and get benefit from them, which is an incentive. People do things that are incentivized more often than they do things that aren't incentivized.
2. Normalizing donation, as above.
3. Realistically a bunch of people were speculating about where I was (see eg https://www.astralcodexten.com/p/open-thread-299/comment/42439504 and https://www.astralcodexten.com/p/open-thread-299/comment/42504375 ) and it would seem weird to lie to them.
The castle thing seems like the opposite of people being corrupted by social approval; they did a genuinely good thing even though they knew everyone would hate them for it. I have immense respect for that. I agree that if (unlike them, but like me) you do something that you could get social approval for, you have to resist becoming a social approval slut rather than being focused on what's really good, but I think it trades off against other considerations. And I think that if you think about that *too* much, then at some level you start becoming an actual masochist who is optimizing for your own suffering rather than make anyone better (Should I help this orphan? No, I would enjoy seeing the smile on his face. Better whack myself in the head with a cactus instead!) and that the point where I worried about posting this for those considerations would cross that line.
I try to discuss these issues more at https://www.astralcodexten.com/p/the-prophet-and-caesars-wife . I feel like there's an old (Robin Hanson?) post promoting being public about your altruism, but I can't find it now.
I'm finally reading Elephant in the Brain, which unsurprisingly is very fascinating, but the most fascinating thing so far is that 95% of (monetary) donations people make is due to solicitation (as opposed to unprompted decision). For organ donations the percentage would likely be even higher, and a respected public figure leading by example is up there in terms of effective mass solicitation.
This is an impressively calm and polite response to an infuriating comment. If I were in your position I would probably be banning myself from my own blog right now.
Congratulations on making such a big (& effective) altruistic sacrifice. Any warm fuzzies & reputational benefits you get from this are very well deserved!
Hear, hear!
I'm fairly sure that in a couple of years time they're going to end up selling the castle because they'll find that they're not using it as much as they expected, and the upkeep costs are way more than they imagined.
This doesn't mean they are not good people, nor am I saying they are not. Just that the castle decision is not a good one.
If they end up using it below capacity for their own purposes, they don't necessarily need to sell outright to recoup the cost. Could simply rent it out to others similarly dissatisfied with pre-existing conference-center venues, then spend net revenue from that on EA. That would effectively mean they were now working at least partly in the real-estate-management business, but if that's where the big money is, and the money still ultimately gets spent on saving lives as efficiently as possible, why shouldn't they?
Renting it out might be a good idea, but it's more work and cost than it sounds like.
I would be interested to see a good argument in favor of buying the Abbey being a good idea.
To my understanding, the case for is:
>CEA (Now EVF) hosted conferences, and aspired to host more and more regularly, and owning a permanent conference center would be more economical than renting every time.
>The Abbey was a large, seemingly suitable property in a good location, and on the market.
>Open Phil wanted to invest in the movement by spending money.
The case against:
>Horrible optics.
>Other properties were apparently available for cheaper.
>It is a Grade 1 listed building, as such any modifications become significantly harder should they become necessary, compared to other properties which could have been cheaper.
>Is it really worth buying a $15m Abbey, or even any sizable real estate, instead of just more malaria nets or something?
Arguments made in favor that I don't think are actually in the case for:
> The Abbey purchase was made with a specific grant with funds earmarked for it by the donor. However the donor was Open Phil who presumably could have been nudged towards another purchase, not some eccentric who would only give money to EA for specifically the purchase of the Abbey.
> The Abbey will retain value and can be sold later. I don't think it has been, despite the dramatic changes to the EA funding space after FTX, so I am a bit skeptical this was ever a pro.
https://forum.effectivealtruism.org/posts/xof7iFB3uh8Kc53bG/why-did-cea-buy-wytham-abbey
https://forum.effectivealtruism.org/posts/xof7iFB3uh8Kc53bG/why-did-cea-buy-wytham-abbey?commentId=3cLRAk98q8jMwhrEc
I don't know the Brits very well, but the American side made a similar decision around buying the Rose Garden Inn (now Lighthaven) building, and project leader Habryka has explained his thought process at length (see some of the comments at https://www.lesswrong.com/posts/9iDw6ugMPk7pmXuyW/lightcone-infrastructure-lesswrong-is-looking-for-funding ). I've also talked to him in person about it, and personally donated to the effort. My extension to the British effort is based partly on this comment thread (https://forum.effectivealtruism.org/posts/oP8YDDJtTGjnH8Nnj/the-lighthaven-campus-is-open-for-bookings?commentId=fNTBeB9CnjrqYx36D) an estimate that the two properties cost approximately the same amount, and vaguely knowing some of the British people involved and trusting their judgment.
My impression is that Lighthaven has gone very well, and the people involved (including me) still endorse their donations and work on it, even though money is tighter now.
(also, awkward to talk about now, but FTX promised every EA organization approximately infinite money in 2021, and if you're the conference-arranging organization and have just been promised infinite money, something like this seems like a pretty obvious next step).
I looked through the thread, and the purchase of the Rose Garden Inn seems like a much better idea than the purchase of the castle.
The Wytham Abbey is a Grade 1 Listed property with all sorts of difficulties in renovation and maintenance. It's gone through a mix of being a private residence and used to host 14 apartments for Oxford. It has terrible optics for being purchased by a charity. The justification appeared to be that it would be used for far more events in the future than had been hosted by CEA in the past, including having residents stay there rather than stay at hotels and commute to a conference center, and would therefor come out ahead, but I am not sure how to find any information on how it has actually been used.
The Rose Garden Inn was a hotel. A nice looking hotel to be sure, but it does seem much more suitable for being the workhorse of an organization that will regularly be hosting large groups of different people. It has much better optics, I don't think anybody has complained about ' charity org buys hotel/conference venue for people to stay at for conferences', or would to the same magnitude as 'charity org buys castle to turn into conference center'. It seems like it's up and running, and is offered for cheaper compared to traditional conference center per day per person costs that I saw thrown around in the Abbey threads. I think it was a good move. It is an actual event venue good for running events that is already being used for running events and may actually be profitable to own.
I wouldn't mind CEA buying a normal hotel/conference venue, quickly turning it around, making it available for use for likeminded groups at a cheap/subsidized? price. I think that's what the goal was with Rose Garden Inn and it worked out really well. Instead, CEA bought Wytham Abbey, which has terrible optics, seemingly less capacity, more building restrictions, less liquidity as such a specialized property, and while I haven't been exhaustive the original post about it was edited on 9/1/2023 and didn't add any information about it currently being in use.
Reading more about the Rose Garden Inn has only more convinced me that the Abbey purchase was a mistake, it seems like after 'Step 1: It would be a good idea to own a permanent conference center' they diverged drastically.
To be clear I don't know much about either transaction but I do have much stronger priors against charities buying castles
Are you worried about people lying about donating kidneys to appear virtuous? Or being peer-pressured into donating kidneys when they don't really want to? Neither of these seem likely.
If you're virtuous, people *ought* to know it. Transparency existed in (paleolithic/metaphoric) Eden. We abhor it today because we don't trust others to follow suit and therefore fear society judging us uniquely anti-virtuous, thereupon becoming subject to the tender ministrations for which the mob is so rightly famous. The consolation of such correctives being administered in the news and courthouses rather than on your doorstep fails to assuage the perturbations of most minds.
But a standard of openness? Why that would be lovely. And it might just help us choose the right people for leadership too.
On a personal note, I consider it a moral virtue to share about myself that I donated two kidneys and also that despite lacking the normal executive skills of even your average 10 year old, I managed against seemingly insurmountable odds to save the life of an old man who was being tortured to death in Chechnya.
EDIT: I did not actually donate any kidneys. The most I did in this regard was speak about Zell Krivinsky for 3 days straight on my radio show after after he donated his own kidney.
But yeah, in an improved society we would definitely be taking into account the red's "needs and abilities" thing, and thus through public discussion come up with a means for resolving (among other things) the distribution of kidneys.
Ideally we'd manage it with a lot less force and at least a touch less gulag.
Instead we might, I don't know, accord honor and love to those who enjoy utilizing their abilities to solve the needs of their brothers?
While my claim of having donated ≥ 2 kidneys is apocryphal, my claim to have rescued an elderly, terifed, abused and doomed stranger is 100% true.
Months earlier I had achieved something like total self abnegation wheresoever my own comfort or pleasure could be keeping me from doing al I could for the life and happiness of my fellow human beings.
I'm sure it sounds mad or bad but it wasn't. It felt good and was good. It was eventually necessary to transcend and to reacquire a biased interest in the individual human unit in whose body I happen to live, but I do not regret having achieved what I imagine very few people have ever achieved. I mention it because it's the only way that something so far beyond my own ken could have even come to my attention, never mind be resolved by me.
When it came to my attention I immediately swore off food, mattress, small talk, etc. and set about informing the various relevant powers and authorities, which turned into negotiating betwixt them which turned into the realization that he was going to be murdered on Adolf Hitler's birthday unless I find a way to free him myself. And, God (or whatever name you might call astonishing Reality) helped me save his life.
All his teeth had been drilled out and he was missing fingers. He had been starved and made to suffer incomprehensible tortures but because of me and only because of me, an old Jewish man was not murdered on Hitler's birthday but was instead rescued on the first day of Passover.
And, much as I was trained to believe and act otherwise by sklavenmoral's third rail, I now believe that it is good for people to know this about me and I am acting upon that belief right now.
I can't tell if this is a joke, fiction, satire, or what, but what on earth are you talking about? Who did you rescue, what was the total self abnegation, and what is sklavenmoral's third rail?
Hey JC, wuddup? If you didn't grok my words on even a macro level there's hardly any point in addressing your micro queries 🤷♂️
I'm here for the people who do understand me - or at least want to.
I'm not here to respond to comments that include the words "what on earth are you talking about" 🤣🤣🤣
I would love to understand you.
You are welcome to read my blog, available by clicking on my avatar to the left, and also to check out my videos on www.youtube.com/@ydydy
But if even if you tell no one, you'll still know yourself, and it will affect your future behavior. This is the missing factor that causes the "ice bath" solution to rise to a score of 3, tying with the Weill center. By having charitable deeds thrust upon them, the donor can remain uncorrupted by virtue.
Taking this further, the truly noble thing to do is to donate other people's kidneys against their will.
And even nobler would be to force yourself, against your own will, to shudderingly harvest other people's kidneys and donate them to save people whom you'd rather be trolling.
Or even better, blackmail or take hostages to get someone else to do the unwilling harvesting! We can keep adding extra layers of rabbinic fences to protect us from the horror of altruism.
Come to think of it, this is probably how a D&D Lawful Evil society arranges to do things that are socially useful but which also count as "Good".
Evil, certainly, but prima facie, I'd have to say this madness is Chaotic as … the Abyss.
Heros have been doing this for a while.
https://youtu.be/D_5nLxZVoPo?feature=shared
Isn't that the same kind of ethical dilemma as the trolley problem - the surgeon who can kill one patient to save five others, or however it goes?
If it's the superior choice to pull the switch on the trolley, then becoming a surgeon so you can harvest organs from non-consenting (because you never asked them, because if you asked they might refuse) donors is also the superior choice!
Hey David Khoop, does the same go for mean-spirited gotchas? I mean, isn't it more dignified and pure to hit the recipient with them in private? If you do them on a forum like this, there's a danger you'll slide into looking for an angle to gotcha from just for the pleasure of being seen biting somebody's butt in public.
Was there really a need to tell the whole world you are a human faceache?
People were wondering even last night as to where Scott was or what he was doing. Now he's told us. And he's told us about how to go about donating a kidney if we want to do so.
This is not the charity of the Pharisees, this is informing us about the need for organ donations and the way to go about it, and the likely obstacles in your way. This is not "look at me, how virtuous I am" - which, by the way, is how *you* come across; "I would *never* tell anyone about my good deeds, amn't I so special?"
Like the apostles complaining about the ointment that could have been sold and the money given to the poor, yeah, you're so specially good.
Buying a castle is self-serving. Donating a kidney is not.
My wife is in kidney failure and is on dialysis. We have the same blood type, and when she becomes eligible for a transplant (she currently has other conditions that make her ineligible in the United States), I intend to offer one of mine, assuming I'm qualified to donate.
Good luck!
I'm happy for you! My apologies for complaining about the lack of posts just yesterday.
As a PhD student, I used to grow kidney organoids - small clumps of kidney tissue derived from embryonic kidney progenitor cells (or Yamanaka-factors induced stem cells). They were amorphous in shape and couldn't grow past a very small size limit: there were no blood vessels inside, and the center of the organoid would begin to necrotize from lack of oxygen. Growing a full-sized kidney in a lab would require a much better understanding of vascularization during embryogenesis.
A cool workaround I once saw in a Finnish lab was to literally 3D-print a microchannel tree, and populate it with thousands of mini-organoids. I haven't been following the field since, so if anyone is aware how close we are to a 3D-printed kidney, let me know.
Also, whenever I told my casual dates what I'm working on, they used to ask "Are you going to steal my kidney?". I would have to explain that I'm literally the least likely person to steal kidneys, since I can just grow them in the lab.
How important of a limiting factor do you think is the risk of it collapsing under its own weight while half-grown?
I've got a weird, tenuous-but-hopeful theory that artificial organs being dependent on microgravity for some key assembly stage might be the key factor that makes early stages of a city-sized station in low earth orbit economically viable. i mean, what else is there that's both high value per kilogram, and has high-volume demand which can't be met more cheaply by building things closer to sea level?
Some kind of ultra pure fibre-optic cable, I think.
I don't really see the potential advantage to making those in space, or how they'd lead to creation of thoroughly human-safe environments which could then build secondary services. Also, saturating low orbit with communication satellites will reduce demand for ground-based fiber - speed of light through air is faster, so a "bent pipe" relay can actually have shorter ping times across continental distances despite the longer path.
https://spectrum.ieee.org/4-products-that-make-sense-to-manufacture-in-orbit
Not sure about scale though. I'm imagining quite a small facility, as part of a mostly whimsical idea for a system where the cables are created as giant lengths trailing out the back of the space station before being parachuted perfectly into position on the Earth's surface!
Ah, of course, diffusion without convection for uniform alloy mixes. Still, that sounds like microgravity is only making certain industrial processes easier and cheaper, rather than "possible at all," and in relatively niche applications.
If artificial organs and tissues overshoot demand for life-saving transplants, retooling into luxury food might be relatively trivial, and there could plausibly be upwards of a billion people who'd eagerly make room in their weekly grocery budget for a few kg of vegan beefsteak.
My only connection to this issue is that I have a friend who attempted to donate a kidney to a stranger through UCSF, and I think ultimately also got rejected or else long-term deferred, for a reason that seemed to also be like "we reject everyone who has an issue that falls into this bucket" rather than "it's plausible that you would actually be endangered if you donated your kidney".
This makes me wonder if UCSF is like super-paranoid about approving kidney donors.
Another thing that could fall under point #7: I think the kidney donation charities or maybe insurance companies are also willing to pay some expenses of a friend or family member to support you in connection with the kidney donation. So you might be able to, for example, take a significant other with you at no charge to you, even if you had to travel for the surgery.
"Open Phil gave most of the funding for the purchase of Wytham Abbey (a small part of the costs were also committed by Owen and his wife, as a signal of “skin in the game”)." https://forum.effectivealtruism.org/posts/xof7iFB3uh8Kc53bG/why-did-cea-buy-wytham-abbey?commentId=3cLRAk98q8jMwhrEc
I was really hoping you hadn't been posting because your wife had had a baby.
Oh well.
You're a better man than I. God bless you.
It's ... not exactly bringing a **new** life into the world, but the counter still got incremented?
Not sure. If a certain ex-boss of mine got the kidney: Nope. - But you got me thinking: What is the second best use of Scott's body tissue to better the world? (The best is his use of his brain to write.) Obviously: sperm. Most likely the UCSF would turn him down - If I were female, I would not. Now I wonder: Why I do not see offers like this more often in the comment section (I saw one on ssc)?
you mean "Scott, have my babies"? lol
;) More: "Scott, I * have YOUR babies". Where * could be: would/will/want to/pray you shall soon.
As an oppressed, transsexual lesbian (ht Titania), I am a non-menstruating person - and can not.
No need to call me Loretta, though. "Embarrassing fanboy" suffices. https://www.youtube.com/watch?v=jlo7YZW8vPA
+1
I was afraid the pause had something to do with the 7th October massacre - e.g. Scott decided to fight for Israel (unlikely as it sounds).
Still hoping to read whatever he has to say about it and the subsequent events.
> $10,000 per year for 10 years
Ah, I see, this is a "trick desperate or low-intelligence people into serving the greater good" sort of deal. That's the only way to describe someone who would actually act upon a promise by the government not to screw them over using the tax code for the next 11 years.
Huh, I distrust the government in a lot of ways but this seems like the opposite of the usual failure mode. Would you like to make a bet on whether the first person to get promised this gets their full payout? Feel free to name the amount and any other terms you find relevant.
My model of DavidC would be reluctant to take the bet. The *first* person to get promised this might get a lot of media attention incentivising the government to do everything smoothly, even if ten years down the line, when the program has faded into normalcy, we expect things to regress to a mean where the government casually screws later donors over.
I understand it's illegal to pay someone for their kidney, but maybe it's not illegal to offer someone an insurance policy against changes to the tax code? Then maybe there's a solution for folks who trust some private insurance company more than the government. (And if the pro-donation organizations are allowed to compensate you for airfare and lost wages, maybe they can also pay your tax-change-insurance premium too?)
That’s not what’s in contention here right?
Like if the government did some funny business that meant the amount of taxes you needed to pay went up by $10k per year, you would still get the full payout of $10k tax credit per year, but you’d still be paying the same amount of tax overall
Also if you get $10k of tax credit you’d be encouraged to do stuff that might increase the taxes you owe by $10k per year so it’d be hard to separate self-inflicted funny business from state-inflicted funny business for the sake of a bet
Just your taxes would go up by $10k a year? Or everyone's?
Just the people receiving the tax credit, I expect it’s normal behaviour for people receiving tax credits to spend more & thus be taxed more
I don’t have confidence that tax credit recipients would be targets for sneaky tax increases from the government(probably the opposite since those receiving tax credits presumably have lobbying power to negotiate tax credits and that lobbying power is probably good at preventing tax increases too)
At least in the US, you're taxed on income, not on what you spend, so spending more would not lead to being taxed more. If you spent it on tax-deductible things, you'd get taxed less.
I missed this because of substack weirdness. My first thought is that I think it unlikely such a scheme would ever go into effect in the first place, with a higher degree of confidence than my claim about what would happen if it did. That's poor grounds for a bet.
But what Edmund said is probably my better second answer. It'll go until it doesn't; I expect the same thing from SS just like everyone else in my generation[0].
[0] Generalization not guaranteed; use caution when handling this hot take.
It is a weird kind of desperation you're hypothesizing.
refundable tax credits are super normal and common. there's a huge program where low-income people get them (EITC), plus various rich people and businesses get them for all kinds of special programs. i don't think it's politically or legally tenable to mess around with them in a general way, although Congress or a state could pass a special law targeting altruistic kidney donors, which also seems extremely unlikely.
We find it acceptable to financially compensate women for egg donation. Not sure why tax credits for kidney donation should be controversial. I believe Iran offers direct payments for kidney donation which carries a higher risk of undue inducement.
I wonder what the actual free market value of a kidney would be. Probably much smaller than $100K because there's plenty of people desperate enough to do it for $10K... although many of these people would have issues (drug addiction) that would disqualify them.
Not sure. I know we pay $7-10,000 on average in the U.S. for egg donation. In Iran, I believe they pay $4000 for kidney donation. I bet it would be a lot higher in the U.S. but probably not $100K. The other question is who pays? The recipient or the health insurer?
I guess it's because egg donation isn't life-saving, and kidney donation is life-saving, and you can't financially incentivize people to do good things . . ?
More likely the reasoning is that egg donation doesn't intrinsically endanger the donor's health... though holding to such a principle consistently would also ban employers from offering hazard pay for riskier jobs at the same skill level.
That and the fact that taking eggs from a woman doesn't impact her ability to produce eggs in the future. A better analogy to kidney donation would be donating an ovary.
We don't pay people to donate blood either, right? Even though it is also safe and non-permanent
Have you found scientific studies which show that the phenomenon of being reduced to only one kidney continues 30+ years after donation?
FWIW the linear no-threshold model of cancer risk from radiation is strongly countered by parts of the world which have much higher background radiation, on the order of the 30 millisieverts you avoided but every single year, and they don't appear to have elevated cancer risk. Similar with airline pilots.
> Have you found scientific studies which show that the phenomenon of being reduced to only one kidney continues 30+ years after donation?
Like, that kidneys don't just grow back after a while?
Can't believe anything without scientific evidence!
He addresses the LNT thing nicely in a footnote.
> In polls, 25 - 50% of Americans say they would donate a kidney to a stranger in need.
> This sentence fascinates me because of the hanging “would”. Would, if what?
The answer is a mix of "if they were introduced, perhaps in a superficial 21-minutes-plus-commercial-breaks documentary fashion, to a particular stranger, who was sympathetic and in need of a kidney" and "if it was 'call 1-800-KIDNEYS and book an appointment sometime in the next month, have the surgery and spend a day or two in the hospital recovering' instead of... well, the entire ordeal you describe, minus UCSF's psychiatric proclivities.
It's also a pretty upper-middle-class sort of thing to do, and I think a fair amount of the people answering "yeah, I'd donate a kidney" never have to really seriously consider the question, because if you're not in a position to take a bunch of time off work and life to go fuck around with hospitals and Zoom conferences and piss jugs and then, on top of all that time, take a solid uninterrupted block of time off work and life to go have the thing yanked out and recover then it's really not something you can ever seriously really consider. Not at all trying to sound "check ur privilege, white kidney-donating male" or scoldy. I just mean it in the sense that it's similarly easy for the fox to say he'd easily resist the temptation of the grapes even if they weren't hanging ten feet overhead.
I worry that the Coalition To Modify NOTA is composed to people who are too nice to think of this, so this suggestion might do good: include a provision that the tax credit will not be INCREASED for, say, twenty years. (I don't know if the government is capable of making such long-term commitments though.)
Can you expand on why you think that would be necessary or helpful? It's not obvious to me exactly what downside you're expecting.
Regret from having donated your kidney too early if the tax credit is, say, doubled the year after you do so.
The obvious solution to that is just to make the credit and any future changes to it apply retroactively to some extent.
Yeah, sure, something like that will be at least as good.
There are lots of obvious solutions once you think of this problem (once you accept that it IS one).
That's a good point. I had _not_ thought of that potential downside (or any of the possible solutions to it).
I was wondering if you've considered getting on the bone marrow donor registry, and if you could write about that at some point in the future? Two years ago at the age of 26 I was diagnosed with acute lymphoblastic leukemia. It's the most common childhood cancer, and one that is highly curable in children, but has a mortality rate that increases sharply with age - my prognosis at the outset was about a 60% chance of surviving five years.
For me, and people like me, our best chances at a cure depends on a bone marrow transplant. Leukemia is a cancer of the bone marrow, so the surest thing to do is use chemo and radiation to obliterate all of your bone marrow, and then replace it with a stranger's who doesn't have cancer. But since your bone marrow makes all of your blood, including your immune cells, putting any average Joe's marrow in there would just cause your new blood to viciously reject your entire body, basically. So a recipient and a donor have to be closely matched on a variety of different factors to reduce the chances of this happening. This makes getting as many people on the registry as possible extremely important, and this also means that when someone is contacted about being a donor, you are often the only donor available for the recipient.
Unfortunately, I did not have a match on the registry, so my treatment consisted of chemo only, without transplant. I am in remission but my chances of relapse are a coin toss. Relapsed leukemia is harder to treat, and it would increase my odds for survival if I had an eligible donor were I to have to return to treatment. It would mean a lot to me if you would consider signing up for the registry (it's pretty easy) and writing about the experience. Thank you!
Edit to add a couple of things after the fact: I'd also like to say that unlike many with organ transplants, bone marrow transplant recipients don't have an expected expiration date following transplant. As long as the transplant is successful, and the cancer doesn't come back despite it, a BMT recipient can expect to live for most of their natural lifespan they would have experienced if they hadn't developed cancer, minus the added risk of future cancers that come with the chemo and radiation necessary to prepare you for it.
And, lastly, most people on the registry won't ever be asked to be a donor, but if you are, being a donor doesn't come at much cost or risk: there are lots of screening tests to ensure compatibility (no CTs I think), but it's not as intensive as what you went through for kidney donation. The actual donation process beyond screening consists of the hospital just giving you some drugs that stimulate your body to make extra stem cells, which can make you feel gross for a few days, and then using a machine to run your blood through a filter that collects those stem cells before placing the rest of your blood back in your body. It takes a couple of hours and I've heard it's a pretty cool experience! Plus, if you and your recipient both consent, the registry will connect both of you two years on so that you can meet each other.
I second this. (I'm healthy and on the registry for many years now, never been approached)
Thirded (I’m also on the bone marrow registry)
Fourthed ( I was on the bone marrow registry for decades but aged out )
I think there is not much to write about until you get the to actual donation part. My registry contacted me once about a potential match, asked me to re-submit my swabs, and I never heard about it again. I hope they found a better match for that person.
Yeah, this is a good idea. I've been kind of scared because I heard it was really painful, but I'll just tell myself that it's a low chance of ever getting called up.
It's not painful anymore! In the past it was, they cored your bone to take some of your marrow. But now they just give you filgrastim (I think) and collect the extra stem cells you now have floating around in your blood a few days afterwards.
Despite having never experienced a catheter I was already a bit afraid of them. This didn't help.
Never had one put in. The idea unnerves me more than the kidney removal. I’d need a healthy helping of Midazolam just to get through that.
I had. Don't remember any problems. Compared to the things I do remember from that time that suggests an upper bound of perhaps 4/10 pain lasting seconds, but more likely just discomfort.
FWIW: I have a phobia around tubes-in-my-tubes so catheters are a proudly horrifying idea to me; even IVs are really upsetting. But when I had to have a urinary catheter during and after abdominal surgery, it bothered me much less than I ever would have imagined a priori. Initially, I was feeling too fragile and exhausted and hit-by-a-truck to care -- these are standard postop feels; painkillers help, even if you aren’t in much pain per se, and it passes -- to be able to muster any f*cks, and when I returned to myself a bit more, it was an already existing situation and causing me literally zero discomfort, so I took a deep breath and focused elsewhere. Even removal was pedestrian. *Extremely* sympathetic about Scott’s bad experience with that.
> It starts with wanting, just once, do a good thing that will make people like you more instead of less.
Then consider this my contribution to the world: I think this behavior is about as admirable as men castrating themselves for religious reasons, or Xhosa killing their cattle for religious reasons.
A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
> I asked them if there was anything I could do. They said maybe I could go to therapy for six months, then apply again.
On the other hand, I find this to be even weirder than the post presents it as being. This remediation makes sense if the concern is that your OCD of 20 years ago might be prompting you to make an unsound decision to donate a kidney today. If the concern is that there's something wrong with your kidney, therapy is pretty well guaranteed not to address that.
> A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
Because it saves a life?
Sometimes the money will do that, and sometimes the kidney won't. The judgment you're really making here is "the kidney recipient is more morally worthy than the money recipient", which has not been established.
As someone who's considered donating their own kidney for a few years (not from EAs), but is on the fence about it, I admittedly don't really understand your line of reasoning here, since for my personal decision making it's 'and', not 'either/or'. I also admittedly find your contentious framing not very helpful, maybe you can rephrase in a way more conducive to changing the minds of fence-sitters like me?
> I admittedly don't really understand your line of reasoning here, since for my personal decision making it's 'and', not 'either/or'.
I'm not really sure what the contrast you're drawing is. I was drawing a contrast between people who pressure you into injuring yourself financially ("bad") and people who pressure you into injuring yourself physically ("good"). I'm not sure what the opinion of society in general would be about a group that pressured its members into doing both of those things, but I suspect it would lean toward "bad".
My objections here are stronger than, but similar to, one of my main objections to EA in general: I don't think it's a good idea to "make charitable efforts" in the abstract. You should have a first-order goal. If an EA's goal is "give to charities that are rated highly by GiveWell", they are just as vulnerable to their donations being wasted as everyone else is, because there's nothing they're actually trying to accomplish. There is no future state of the world that would inform them whether, when they previously donated to a recommended charity, that worked out well or poorly.
So, according to me, your charitable efforts should be directed at things that you think are problems. The tycoon who funds high-powered basketball contracts for his local team is concretely addressing a problem that he can perceive (and that other people in his community share!). He counts as more charitable than the person whose goal is "donate to the proper charity, whichever one that is, I'll ask someone else".
If your advocacy for kidney donation is based on your need for a kidney, or your personal scars left by a loved one who needed a kidney, I will call it admirable. If you do the same advocacy because you think calling on other people to donate kidneys sounds like the type of thing you should do, I will call it reprehensible.
And similarly, if your donation of a kidney is motivated by the need of someone you care about, I will call it admirable, but if your donation of a kidney is motivated by the need of someone you've never heard of, I will call it stupid.
Your comment reminds me of something I read (I forget where) denouncing "nonempathic altruism." The point was that you ought to CARE about the people you're supposedly trying to help.
On the other side, Paul Bloom wrote a book *Against Empathy* which partly argues that caring is sometimes irrelevant or counterproductive.
I'm somewhat confused about my position on this.
> The point was that you ought to CARE about the people you're supposedly trying to help.
But I don't agree with that point. I'm saying you ought to be trying to solve things that are problems for you, and you shouldn't be trying to solve things that aren't problems for you. There are two primary reasons: (1) if you follow this policy, you will be able to tell whether the problems are getting better or worse; (2) the fact that you personally have a problem serves as evidence that at least one person has a problem.
This may intersect with your interpretation in that, if you care about the people you're supposedly trying to help, then their suffering is a problem for you. But the analysis is different. Note that I called advocacy reprehensible (you are setting out to hurt other people) and donation stupid (you are hurting yourself). By my reading of your comment, you think I'm calling donation reprehensible.
If Scott had met the recipient beforehand, would that make a difference? Even if the meeting was solely because of his prior decision to donate? What about if he had the option of meeting the recipient, but for some reason it didn't happen?
Do you have to know them in advance? I've volunteered at a place that feeds homeless people. I knew no one involved when I started, but got to know a few people while doing it. In a way, it was a sacrifice of my time, which is like a sacrifice of my life. But in another way, it was an experience that became part of my life. Perhaps Scott wants this experience to be part of his life.
There was a fascinating EconTalk podcast, almost a decade ago: 2014-07-14, "D. G. Myers on Cancer, Dying, and Living". In it, Myers said something that I think was profound, even though I'm not religious: "[God] didn't *plan* it; this is the history He wanted for me."
> If Scott had met the recipient beforehand, would that make a difference? Even if the meeting was solely because of his prior decision to donate?
To the second question, that would be the difference between trying to address a problem that you have, and trying to afflict yourself with a problem to address. I don't see them as similar.
To the first question, let me answer in a larger scope: the propriety of donating a kidney depends on how strongly you are connected to the recipient. Having met them is not necessary (but would, if the donation were appropriate, almost always have happened) or sufficient.
> Perhaps Scott wants this experience to be part of his life.
That would not be enough to make his decision admirable.
No one in this story was pressured into doing anything. Scott made a choice of his own volition.
Yes, making a choice of your own volition is how being pressured works. That's why it's not called "being coerced".
"You don't personally know the person you're trying to help/their scars are not your personal scars" is different from "there is nothing you're trying to accomplish". "Helping people you don't know personally" is a thing one can try to accomplish.
Also, there is no such thing as "making charitable efforts" in the abstract. It requires doing a concrete thing with actual effects, such as picking a particular charity and supporting them. Helping people you don't know is not helping abstract people in some Platonic realm, they're actual people, they just don't happen to be on your list of friends.
Helping only those on your friends list is _very_ limiting. What if my friends are doing OK, but I know that some other people are not? Am I supposed to pretend that those are just stories told by malicious Djinn and the only things that are real are the things I see with my own eyes while personally present, not even a direct video feed counts, because someone might have faked the video? It's theoretically possible that someone might fake any video I see, sure. But I'm not that much of a solipsist. I can even (shock, horror) read a book and believe there's a decent chance the words in it relate to actual things, despite the fact that creating a book that says false things is easier than creating one that says true things. Shockingly, I can believe that the words I read before writing this post were probably written by a real person who will later read my words and be affected by them in some way, even though this is _an Internet comments section_. Admittedly, sometimes I do doubt whether something I read on the Internet was written by an actual person and suspect I'm wasting my time, but for the most part, the conversations I engage in seem worth it. And similarly, sending money or useful goods or services to people I've never met through an organization composed of strangers, based on information written by other strangers about places far away, often just works as advertised, as best I can tell. Sometimes not, but often so.
According to you, my charitable efforts should be directed at things I think are problems. Well, I agree, that's obvious. I just think, like, people dying all over the place in developing countries or suffering because of stupid things that can be fixed for a few bucks _is a problem_, even if I don't know their names. It's a problem I'd like to do something about. And there are means available for me to do that, and requiring me to make new friends first seems like an awful and useless hurdle. And thousands of people waiting on an organ recipient list, is also a problem, and one which there are means to solve. I can see how you might be concerned that someone might spend some money I give them on something for themselves rather than something helpful to the people I want to help, but like, what's the equivalent of that, for kidneys? You can't buy a yacht with kidneys. Most likely if I donate one, the doctors will try hard to make sure it gets into someone who needs one.
Not really, it's more about directness and probability. The kidney goes to a particular person, who has a known high probability of living because a specific thing that was wrong got fixed. The money is fungible, and with regards to "cults", the phrase "hookers and blow" comes to mind.
... Unless you're referring to Effective Altruism as a cult? While there are cult-like aspects to EA, they're also quite good at providing the numbers and math for what the money will do, which in this regard puts them ahead of pretty much every other group out there.
> ... Unless you're referring to Effective Altruism as a cult? While there are cult-like aspects to EA,
Look at Scott's description of his decision-making process:
> my girlfriend ending up begging me not to donate, and I caved.
> When I talked to my family and non-EA friends about wanting to donate, the usual reaction was “You want to what?!” and then trying to convince me this was unfair to my wife or my potential future children or whatever. When I talked to my EA friends, the reaction was at least “Cool!”. But pretty often it was “Oh yeah, I donated two years ago, want to see my scar?”
> After I submitted the donation form, I was evaluated by a horde of indistinguishable women.
> they all had questions like “Are you sure you want to do this?” and “Are you going to regret this later?” and “Is anyone pressuring you to do this?” and “Are you sure you want to do this?”
On the one hand, you have everyone close to Scott, plus the impersonal medical system, stressing that this is a bad idea and he shouldn't do it. On the other, you have a group of erratic weirdos who like to talk each other into following through on bad ideas, and they provide support, encouragement, and role models for this one.
One could say the same thing about a group of slavery abolitionists 200 years ago.
Also, I wouldn't characterize the impersonal medical system as saying that it's a bad idea. I take those questions literally. They're important things to ask. Sure, it sets off our social sense because the same questions can be used as code for "this is a bad idea and he shouldn't do it", but the context is different.
> One could say the same thing about a group of slavery abolitionists 200 years ago.
I'm not sure what "the same thing" refers to. That they were a cult? That their characteristic behaviors were due to pressure from other abolitionists? That they liked to talk each other into following through on bad ideas?
I don't quite see the parallels there. It would be easier to say they could also be described as erratic weirdos, but I don't really see that as a central theme of my comment above. I included that to form a closer parallel to the paradigm of "cult".
Yes, one could, and I WOULD, say the same thing about slavery abolitionists. And about vegans. And about abortion abolitionists. And libertarians and anarchists. And men's rights activists, and white civil rights advocates. (I made sure to list a few causes I personally support.)
There are many causes that seem (and therefore ARE) righteous to those on the inside while simultaneously insane and/or evil to the vast majority outside.
The heuristic about avoiding cults is very good. But beware of heuristics that almost always work: https://www.astralcodexten.com/p/heuristics-that-almost-always-work.
> Also, I wouldn't characterize the impersonal medical system as saying that it's a bad idea. I take those questions literally. They're important things to ask. Sure, it sets off our social sense because the same questions can be used as code for "this is a bad idea and he shouldn't do it", but the context is different.
Note that this argument is incoherent. Those questions are not important things to ask, unless the action they apply to is recognized as a bad idea. If the cashier at Taco Bell made sure to ask whether you were being coerced before ringing up your order, it wouldn't be possible to explain that by invoking the idea that the question was important to ask, because, obviously, it isn't. Instead, we would explain that by reference to the cashier being mentally unsound.
The premise that asking the questions is important already assumes that the course of action is a bad idea.
If it's irreplaceable you're concerned about, you could donate half your liver (it'll grow back!) or some bone marrow.
"A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?"
Because you're not handing it over TO the cult, duh.
"Indiana Jones and the Temple of Doom" would beg to differ.
I agree, because the leaders of this movement are installing 90% of donated kidneys into themselves, gaining the ability to filter spacetime itself.
For most people, the problem with giving your money to the cult is that it flows into the pockets of the charlatan at the top rather than toward any sort of greater good. Perhaps you find altruism in general to be a repellant concept; this certainly seems to be the case from subsequent responses. You claim to advocate for altruism that solves some defined problem. Yet Scott's kidney was successfully implanted in someone who needed one. That's a definite, concrete change in world state, unlike giving money to a broad, generic 501(c)(3).
But at least this post was silly enough to get me to register.
With opinions like that, you'll always have a job available at the Guardian if you want it!
I think you genuinely hold this opinion, but are also a troll.
> A cult that talks you into handing over your money is vilified; why is a cult that talks you into handing over irreplaceable pieces of yourself 𝘣𝘦𝘵𝘵𝘦𝘳 than that?
It is not plausible that you cannot independently grasp the differences between, on the one hand, 'enrich a cult's leaders and finance its activities' and, on the other, 'save the life of a stranger' -- nor that you do not understand why, for Scott and most of his readers, these differences are morally decisive.
I'm sure you really do hold values that render altruistic acts like this contemptible, groups that encourage them reprehensible, etc. etc. But you chose to express this opinion, which would necessarily be rather inflammatory in this context even if posed thoughtfully, by... tossing off a couple of insulting analogies (which you know are insufficiently analogous to kidney donation to illuminate anything but your feelings), followed by a rhetorical question that could not be posed in good faith by someone who had spent more than 5 seconds thinking about it.
Everyone else, please consider following the ancient wisdom and Not Feeding The Trolls.
> It is not plausible that you cannot independently grasp the differences between, on the one hand, 'enrich a cult's leaders and finance its activities' and, on the other, 'save the life of a stranger' -- nor that you do not understand why, for Scott and most of his readers, these differences are morally decisive.
This is an interesting contrast with my response to MoonMoth, which he didn't agree with:
> The judgment you're really making here is "the kidney recipient is more morally worthy than the money recipient", which has not been established.
You've come along to argue much more forcefully that what's important to you is that the money recipient is not worthy and the kidney recipient is. That still hasn't been established.
I am noting that the harm suffered by the victim is worse in the scenario we're being called to admire than in the scenario we all politely agree to vilify, and that this is incongruous.
> But you chose to express this opinion, which would necessarily be rather inflammatory in this context even if posed thoughtfully, by... tossing off a couple of insulting analogies
When someone makes a big public announcement "I've started cutting myself. My parents don't like it, but I'm doing it anyway because I want the public acclaim" ... when could possibly be a better or more appropriate time to respond with public condemnation and scorn?
> a couple of insulting analogies (which you know are insufficiently analogous to kidney donation to illuminate anything but your feelings)
This I just see as wishful thinking on your part. They're close analogies. They're not exact analogies.
I think the concern is that OCD can cause obsessive thoughts like not being good enough and needing to do more, scrupulosity, which seems like a bad reason to donate.
No arguments, no discussion, just: Im reading you for about twenty years now, and you never stop to amaze me. Blessed be you.
<3
(either your calculation of years is off, or I somehow knew you in college - are you an old friend under a different name)
I found your very first blog by accident when a book review on native indians you wrote became famous, I read it, loved it, and then went to the first of your posts on that blog, where you described a hike after finishing high school. Loved that and then never stopped reading your stuff since.
Yup. Scott's awesome. I'm an occasional reader and a big fan. Brilliant, funny, knowledgeable, kind, about as honest as one can be in the world of online opinionating and usually correct as well.
Never met him yet but the dude's awesome.
Just want to say how it never fails to surprise me to encounter people in their 30’s who never have experienced anesthesia.
Out of curiosity, why? My prior is the opposite (assuming you mean general anaesthetic) so I am metasurprised by your surprise. But I don't know the numbers.
Childhood trauma of course, what else :)
But seriously, I had some broken bones as a kid, and so had my best friend, and then many people I knew growing up (some similar to what Xpym describes, dumb mistakes resulting in unpleasantness) had various surgeon encounters. So I grew up with a prior "most people have been in an OP".
And whose parents don't get swindled to put their 17.9-year-old under general anesthesia to remove ONE wisdom tooth "while your insurance still covers it"?
Several years later, we all learned that wisdom teeth can just as easily be removed under under local anesthesia.
This makes me wonder if this is a UK-US distinction. A quick bit of Googling suggests that indeed general anaesthetics administered per capita per year is on the order of two times larger in the US than here in the UK.
That would explain it! Are you in the UK? Here in the US pretty much everyone gets it at some point..
I had a wisdom tooth extracted with only Nitrous, didn't hurt at all. YMMV.
because you'd be very lucky to never have had any minor surgery that required it - it's very common for all sorts of things
I'm in mid-thirties and only once had a minor surgery under anesthesia, which happened due to a dumb mistake that I might as well not had made.
I avoided any medical interventions until my forties when I did have to be sedated under general anaesthesia for an endometrial biopsy. One of my siblings, on the other hand, was sickly from a baby onwards and had several hospital stays. Luck of the draw, I guess? 🤷♀️
I didn't have it until my first colonoscopy. I've also never been hospitalized except for one overnight where it was possible I had had a heart attack but it was acid reflux, which, for those who haven't had the severe form, feels like getting kicked in the stomach.
N = 1, I had general anesthesia for the first time in my life when in my mid 70's. Maybe just lucky.
Thank you everyone, quite a variation of experiences!
Three things:
1. How do you know it was zoom doing it? Maybe they were spontaneously donating body parts and replacing them with UCSF insignia.
2. The Pros and Cons chart is flawed. It weights each factor equally. I, for one, definitely value some more than others. Cornell may not be on top after all.
3. "previous living kidney donors" sounds more Halloweeny than was probably intended.
Beyond that, congratulations!
lol'd:
"I make fun of Vox journalists a lot, but I want to give them credit where credit is due: they contain valuable organs, which can be harvested and given to others."
"I practiced rehearsing the words “I have never donated to charity, and if I did, I certainly wouldn’t care whether it was effective or not”."
"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."
"I had an unusually hard time with the catheter - the nurse taking it out frowned and said the team that put it in had “gone too deep”, as if my urinary tract was the f@#king Mines of Moria"
I'm glad you didn't donate your sense of humor.
I didn't read as far as the 4th section (and shame on you for tricking me into reading what I'd avoided! 😂) but when I read the first one I laughed out loud and wamted to share that but had no other comment to make on it.
I recently came across one of his corrections that read something like, 'whole I agree that (x y z)... saying that Vox isn't absolute garbage may have been overstating it'.
I started typing a comment but I realized it would be so long I might as well work on a "Contra" style article for "Why you should not donate a kidney".
If you are a person that's seriously considering donating a kidney please consider contacting me at george @ cerebralab . com -- so that I may try to dissuade you.
I think this would help me write a better article by having a motivated adversary with skin in the game.
P.S. In case Scott is reading this I'm obviously *not* claiming that donating a kidney isn't an altruistic act. I think that you are a fantastic person as always for doing this, I am just against encouraging people to do it because the uncertainty around outcomes seems immense and potentially bleak. Which still means that on-average you saved QALYs and contributed to social cohesion making you an all-around good person for doing this.
P.P.S Hopefully no new rules around posting emails in comments, if one exists and I'm breaking it, I'm sorry
Definitely interested in your thoughts about this, though I'm against donating kidneys.
what's your email? I'll send a draft
How transferable is the 'kidney credit'? My wife is at elevated risk of someday needing a kidney, so I always figured I should keep my spare in case she needs it. I would be very upset if I gave it to somebody else now, and then 20 years later found myself unable to leverage my past donation to bump her to the top of the current recipient list.
I'm not sure I understand your question. You could always put her as the only person on your list of people you were giving a credit to. But I'm just guessing here - if you're really interested in this, you should contact WaitListZero (link at the bottom of the post) and ask them.
Sorry for the confusion, I missed your footnote #7, it answers my question -- this is good to know! It actually makes it so that if I gave somebody else my kidney now, I could designate my wife at present to be the beneficiary of some other kidney in the future. It's like kidney insurance -- in the event she that outlived me and needed a kidney when I'm no longer around to give her one (or I'm just too old to be a donor) she could get one on account of my having given one away before. Duly updated!
Could I put my future unborn children on that list? If I don't know their names yet?
I was also wondering about this. Or if the names could otherwise be changes, what incentives that creates.
The only thing that bothers me about this is the opioids bit. When my father had issues with a kidney stone, they gave him morphine, and he was in utter amazement of how effective they were, and came out of the experience saying "I can understand how people get addicted to this stuff." I've heard about how people getting their start on opioids because they're prescribed them following surgery.
When I had a tooth extracted(which incidentally also included that kind of lying-in-chair->timeskip->staggering down sidewalk anesthesia experience), I specifically avoided taking the heavy duty pain killers they prescribed me because I didn't want to roll the dice on going down the path of drug dependency.
It's all well and good that it's a relatively safe surgery, but I'm wary of any unnecessary exposure to opioids and would need to know the risks there.
I was looking forward to trying opioids, in a sort of Ulysses-tying-himself-to-the-mast way: I'd heard so many things about them, and wanted a chance to try them without getting arrested.
I joked in the post about how good I felt, but it was actually just a normal amount of pretty good - hard to bother, comfortably warm, easy to drift into pleasant sleep. I tried a higher dose at home when I had my UTI, and had a similar experience, then very unpleasant constipation for the next few days. I currently have a bottle of unused opioid pills on my desk that I haven't touched for a couple of days despite enough pain that I could easily justify it, mostly because of constipation risk. My guess is I'll continue not to use them until the next time I'm in extreme pain for some reason, even though I usually have a pretty experimental approach to medication.
My impression is that happy people without pre-existing mental illnesses or addiction problems rarely get addicted to opioids in the period after a surgery. Partly this is because people with addictive personalities form a separate group who already know this, partly it's because addiction is an interaction between genes and how good your life is, and if your life is good you need to be very genetically unlucky. Partly it's because you'd normally need higher doses, faster-acting chemicals, and longer timespans than a typical post-surgical course to get addicted. And if all else fails, most people won't have the energy/interest/knowledge to find a new source after their prescription runs out.
I think all of this is compatible with the extent of the opioid crisis. I think I remember seeing some studies that people who die in the opioid crisis mostly aren't normal patients who got post-surgical prescriptions, but the people who stole/bought/cajoled opioids from those patients.
Very similar experience here, minus the constipation. Had several occasions to take them after various surgeries. Warm feeling of calmness and not-giving-a-fig. Zero desire to take them after the pain subsided.
That matches my experience as well, with one difference: I kept taking the opioid as prescribed (as in, take X every Y hours) even though I wasn't in pain (because you're supposed to follow the directions, right?). I ended up stopping because I noticed I was getting very irritable in the hour or so before it was time to take my next pill, and I was looking forward more and more to the warm sunny feeling I would get.
I come from a family with a history of alcoholism, so when I realized I was getting irritable I threw them away out of an abundance of caution. Sure did feel good though.
Oh I absolutely ignored the prescription timing and took it only when the pain became really "not ok" (I don't know... 7 out of 10? I never understood this scale, is the 10 "the worst possible"? how would I know what that meant?). I was worried about sliding into dependency without even noticing it.
I got a few opioid pills when I broke my arm a couple of years ago, even though it mostly didn't hurt if I kept it still. I tried one the first day, and in addition to making the pain go away, it also made my PTSD go away. I promptly stopped taking them and have saved the rest in my closet in case things get very bad,. My prediction is that they'll just sit there and eventually expire. Cannabis isn't as effective, and has more side-effects (the whole "stoned" thing), but also is easy to acquire where I am, and has much less potential to be addictive.
But now I have a suspicion about why heroin and Vietnam were so associated.
> When I had a tooth extracted(which incidentally also included that kind of lying-in-chair->timeskip->staggering down sidewalk anesthesia experience), I specifically avoided taking the heavy duty pain killers they prescribed me because I didn't want to roll the dice on going down the path of drug dependency.
When I had my wisdom teeth out, they told me to take Valium beforehand.
Not for any medical reason. It would have provided no benefit at all. But my father didn't know that and he said I should take the Valium because those were the instructions.
My mother, a doctor in an unrelated specialty, supplied her opinion that the Valium had no purpose, and I didn't take it.
But I experienced far more anxiety over the prospect of being forced to take Valium than I did over the concept of having my teeth extracted.
As you might gather from my comment, I am still outraged about this.
I suspect the reason they told you to take Valium beforehand was to keep you from being too nervous about the procedure. The same thing happened to me when I had difficulties with an IUD installation, and I took the Valium, and I thought it was a good thing in that it helped me be calm and easily compliant going into the procedure.
Obviously if the idea of taking Valium causes you more anxiety than getting your teeth extracted than you shouldn’t take it; but I think it’s a good thing that it’s offered, (better if it’s offered with a better explanation!), just to help you actually show up and let yourself be strapped down to be cut into.
> but I think it’s a good thing that it’s offered, (better if it’s offered with a better explanation!)
That's the thing, it wasn't offered. No one said "do you want to take some Valium before the procedure?" Instead, they gave me Valium and directed me to take it.
That sounds like being offered to me... what is the difference?
The difference is in whether you have a choice.
I didn't take the Valium, but in order to do that I had to specifically violate medical instructions. I opted into a choice that was notionally forbidden to me. I don't find this acceptable.
You really don't think there's any difference between an offer and a command?
I think it's a little silly to treat a painkiller as a "command" having any authority. It's pretty obviously something that's prescribed as needed and clearly intended as optional.
I've taken opioids after major surgery. Their effect on me was to dial down the pain from a full boil to a simmer. That's it--no psychological effects of bliss or euphoria. Now, I was taking the prescribed dose, and probably if I took a lot more the effect would have been different. Once I healed a bit, I had no problem stopping taking them, and in fact still have a bottle of oxycodones in the back of my bathroom closet.
I have had morphine by IV to kill pain from a dislocated shoulder and kidney stones (separately), and didn't particularly enjoy it. It started with an unpleasant, nervous kind of warmth in indeterminate location, which soon faded, taking down the pain with it. The pain didn't go away, but it seemed more like I no longer cared about it.
I have had Norco and Oxycodone, which worked moderately well.
I have had no inclination toward addiction with any of these, which is only, of course, anecdotal, so your experience may vary. I'm not sure taking prescribed medicines as prescribed is "rolling the dice" unless you have some other prior susceptibility to getting addicted. If you feel a need to refill the prescription after the original need for it (such as pain) has gone away, that would be a bad sign.
I took opioids twice in my life. Once, after I got a wisdom tooth out. I was in pain for days, opioids weren't helping, and I took higher doses than prescribed. I felt no effect whatsoever. No high, no anesthesia, nothing. I even powdered and snorted a pill, to no effect. But there was one effect. I must have gone stupid at some point. I pulled out my dissolvable stitches. And then I forgot about it. I remembered that "the doctor will be angry with me" but I could not remember why. Figured, it must be because I ate three weeks of oxys in 5 days. Surprisingly, he wasn't angry. He gave me more oxys, because I guess you get more of the same thing when you say it's not working. But he said to try Motrin, too. One pill of Motrin took the pain away completely in 15 minutes. One. Frigging. Pill.
(Half a year later, I watched a medical show. On the show, a doctor cautioned her patient to come back to get the stitches out or else they'd heal like a railroad... and that's when I remembered that I'd pulled out my dental stitches!)
Second time, I used my dental leftover opioids for an ear infection. They worked this time. Again, no discernible effect on my mental state.
Since then, I got a pilot's license. Heard a few horror stories about how FAA will make you submit a book's worth of paperwork to prove you didn't get addicted to those 5 pills prescribed after a surgery. So I never took opioids since.
Asking doctors for "something other than opioids" is like a secret password to getting them prescribed to you by the bottleful. Skin infection? Here's some opioids! Minor surgery? Here's a month supply! Dental nerve dying pain? Here you go, to take the edge off on your 6-hour drive to your root canal referral. My apocalyptic meds tote is 60% unopened opioids and 40% every other prescription I hadn't finished. I once told a doctor that I haven't been taking my opioids because they rolled out of the brown baggie and got lost in the car somewhere... so he prescribed me more!
Well, if you asked directly, that'd be Drug-Seeking Behavior, and they could get in trouble.
I don't think I would donate my own kidney, due to various emotional reasons none of which are all that thoroughly-considered... but I would gladly vote in favor of the tax credit. That seems like a rare free lunch in national economics. I hope it gets traction.
Speaking of traction, glad to hear you're on the mend, and great write-up.
Hey, someone else with a Calvin avatar. Hope nobody gets us mixed up. Bill Watterson rules!
Typo: "They found 34 cases extra cases"
Soo, do journalists finally get to claim that AE is a cult that steals people's organs?
ALT
Simpsons did it first (S10E8).
On a less facetious note, I find the data on the safety of kidney donation incredibly unconvincing. Vast majority of donors are elderly and have shared the lifestyle of the recipient for decades (stereotypical old couple situation), so tons of confounders and no good data for young people donating. To handwave a safety signal as genetic confounding is incredibly disingenuous when you have no good data to suggest this link, i.e. can't pinpoint the gene responsible.
In general, I find myself wishing sometimes transplant medicine would just, dunno, go away. The results I see in my daily practice are always crap (I am the person who gets to stare at the nice little pictures you had taken all day long). It's far from the miracle everybody thinks it to be, and certain subpopulations might actually be worse of getting an organ than without it. There are practically no randomised trials on transplantation, and the devil kidney in me tells me it's because transplant docs know well enough that it would fail when actually trialled in today's population.
The ethics is fraught with foregone conclusions and false causality (people don't die from a lack of donor organs - they die from their illnesses - yet this language is routinely used by patients and their families: I was recently told by an acquaintance her grandfather had "died because no organ was available" - no seriously eff this gramps died of his alcoholism and two packs a day you delusional excuse for a granddaughter - he was my neighbour). If we are to believe all democracy becomes gerontocracy in the end, I get the heebie-jeebies when thinking about what a government seriously committed to placating the elderly would mandate in that respect.
I hope for your sake this turns out fine, lotsa people with only a single kidney end up as old geezers, but I can't help to think the "advertise kidney donation like blood donation to everyone" moment is a greivous error in the long run and this will fall medicine on its feet colossaly in the years to come. In the short term, this article has demonstrated to me that this blog now espouses values so far from me and mine own that it's probably time to stop reading it.
"To handwave a safety signal as genetic confounding is incredibly disingenuous when you have no good data to suggest this link, i.e. can't pinpoint the gene responsible."
I think this comment ignores the past few decades of genetics. Figuring out the percent of something which is heritable is vastly easier than figuring out what genes are involved (it's never "the gene responsible", it's usually a mix of hundreds or even thousands). Still, when we do get polygenic algorithms, they've shown that the simpler gene-agnostic methods we used earlier to estimate heritability were right.
Although I agree it's unfortunate that you can't do RCTs for kidney transplantation, statistically adjusted studies continue to show the 5- 7 year lifespan and 20% quality of life gain. Before-and-after surveys of the same people also show the 20% quality of life gain, and people say they feel much healthier. There are obvious practical downsides to dialysis and everything we know about it biochemically suggests it should work less well than a kidney. AFAIK every group of nephrologists and medical evidence-setting body agrees kidney donation works better than dialysis. See for example UpToDate, https://www.uptodate.com/contents/overview-of-the-management-of-chronic-kidney-disease-in-adults, ("Kidney transplantation is the treatment of choice for ESKD. A successful kidney transplant improves the quality of life and reduces the mortality risk for most patients when compared with maintenance dialysis") and this paper by the National Kidney Foundation: https://sci-hub.st/https://pubmed.ncbi.nlm.nih.gov/18256371/ . Curious if you have any links or evidence supporting your position.
"People don't die from a lack of donor organs - they die from their illnesses" sounds incredibly facile to me - not just "guns don't kill people, people kill people" facile, but "that person didn't die because of the gunshot, he died of blood loss" level facile. Just say that the result of getting one extra organ would be to save one extra life over the counterfactual.
My understanding is that people who are extremely old and decrepit are considered lower down on the list for transplants than everyone else. My grandfather, who was pretty old when he got ESKD, AFAIK was never even told to consider the options.
I agree that we seem to have some pretty irreconcilable value differences.
The main thing we learned from the last decade of genetics is that neither of these methods work. The few diseases that have a strong genetic contribution are practically monogenetic (ApoE4, PCSK9, ...). Whenever a study reports these minimal point estimates for hundreds and thousands of genes, that is essentially the result you would get from a non-genetic disease: hundreds and thousands of genes that minimally contribute to or detract from the overall resilience of the organism. Don't tell the geneticists, though, they'll get upset because they'll loose their funding once the agencies figure it out.
There is a actually a very straightforward reason for the autoimmune kidney disease they found: surgery introduces antigens from the kidneys to the bloodstream, thereby causing immunisation. The mechanism would be the same as in sympathetic opthalmia, where immune-privileged antigens from the intravitreal space get introduced to the immune system at large by trauma or surgery and then cause an autoimmune response to the entire organ system, eventually destroying both eyes. Replace 'eyes' with 'kidneys' and 'vitreal' with 'tubular' and you got yourself a deal, mate.
Re quality of life or survival gains: this is flawed evidence on all levels - without an RCT, the Ioannidis principle comes to mind: in a null field, observed findings are a measure of the prevailing bias. Control groups are likely sicker or historical, i.e. generally worse off. Also, my claim wasn't that this is a negative for all involved or even on average, but that selected subgroups may be worse off with a donor organ. This changes the calculus quite a bit from a medical perspective (you wrote so eloquently about that a few years ago re/ death risk from seroquel), but since no reliable data is being generated, nothing will change for a decade or so at least. When transplantation goes awry, the disease is blamed. When it goes well, the surgery is credited. This is as embarrassing as it has been effective in cementing the practice.
Finally, the argument is not as facile as you would like it to be. There is no moral causality between the availability of donor organs and deaths. Were there, then everybody who is currently keeping their two kidneys for themselves would be a murderer (or whatever your term would be for "person who is obligated to help but doesn't, thereby causing death"). This obligation doesn't exist, though, and previously this was an accepted view amongst medical ethicists. Since the explosion of utilitarianist bullshit in the wake of Singer's success in the academy, this slowly changing, and I dread to think where it will lead us.
I do not think one can compare donating a kidney to someone who needs one to dying of blood loss instead the gunshot. Would you say someone died of cancer, or because we haven't yet found a cure for that cancer?
I do see the point in saying an illness (such as a faulty kidney) killed someone, rather than saying lack of a donor killed someone. The second phrasing seems to me to take away some of the altruistic sense of the kidney donation, making it more of a duty of a donor instead of a freely offered gift.
"The ethics is fraught with foregone conclusions and false causality (people don't die from a lack of donor organs - they die from their illnesses - yet this language is routinely used by patients and their families: I was recently told by an acquaintance her grandfather had "died because no organ was available" - no seriously eff this gramps died of his alcoholism and two packs a day you delusional excuse for a granddaughter - he was my neighbour). If we are to believe all democracy becomes gerontocracy in the end, I get the heebie-jeebies when thinking about what a government seriously committed to placating the elderly would mandate in that respect."
I don't know, friend; I had a cousin who got a donated kidney and indeed would have died without the transplant operation. He did die several years later, so you could argue that the gain wasn't worth it, but how do you decide the value of "lived extra years to see his children reach adulthood"?
My late father, for reasons we never got adequately explained (I personally think it was due to side-effects of medication) underwent drastic collapse to the point that he had to be resuscitated three times in hospital (and my family was asked, after the first time, did we really want this, with the heavy-handed implication that we should just let him die; my mother refused adamantly to consider this) and was put on dialysis, and eventually sent home from the hospital with the clear, on their part, expectation that they were sending him home to die. He was in his seventies at this stage, so they were going by "well he's had his life, why drag it out?"
My mother and I nursed him back to health, to the point where he was able to be active once again, and was doing so well on dialysis that the hospital considered cutting him down to only once a week (the consultant referred to him as "my miracle man" when doing rounds with medical students, our opinion on that was "yeah this is only because we stopped you guys letting him die"). His eventual death was not due to the kidney problems but a stroke brought on by blood clot due to venous embolism which the casualty department (emergency room) didn't recognise and sent him home with a "sprained ankle". By then he was just starting his eighties, starting to decline, and very lacking in motivation since my mother's death. He was ready to die by then, but he had an extra decade of life because we didn't obediently go along with the hospital about 'let him slip away' the first time.
So while there definitely can be too much intervention where a natural death is better, there's also the opposite where people who could have good remaining years are written off too early.
I will keep reading, but I also definitely realized that Scott's values are dramatically different from my own. But for me, it comes down to the fact that if I'm going to mutilate myself, it has to be a warm decision, and not an output of cold rationality, that is, the kidney would have to be donated to family or someone I love. I mean, I signed the Giving What We Can pledge, but compromising bodily integrity for the sake of a stranger just seems wrong.
However, I wonder if every monastic of every religion in the world could be persuaded to do this, as this would be, after all, consistent with their principles. A quick search suggests this would be 11,000 kidneys, which is nothing to sneeze at.
why read, if not to read those whose values differ from your own
Flattered to have caught your interest, however briefly. You have mentioned you have traditionalist friends, which is really interesting. You ever tried to read Rene Guenon, who is along many axes the anti-thesis of everything you believe? He is not hateful though, don't get it twisted, even if he believes everything since Descartes has been a mistake.
Explain more - what does he think?
Basically, he believes the only possible way a civilization can work is in a traditional manner: spirituality, a legitimate spiritual tradition, needs to be at the very core of the civilization. The last time the West had this was in the Middle Ages, and it all started falling apart with Descartes, till we got to the present day, where spirituality is marginalized. He believed the East to be superior to the West for this reason, though he did not get to see the secularization of China and India.
Along all that there is also the perennialist project: to show that all the various spiritual traditions are actually in agreement in fundamental matters, which does not mean on morality (he regards that as secondary to all this), but rather, on actual metaphysics, truths from beyond.
I really like the work of the perennialists actually: the properly spiritual view is to see the harmonies, or at least, don't let the differences make you think there is an irresolvable conflict.
I agree - I share the intuition that "compromising bodily integrity for the sake of a stranger just seems wrong."
I just wish to say that I am unironically very inspired by "Everything else I try to do, there’s a little voice inside of me which says “Maybe the haters are right, maybe you’re stupid, maybe you’re just doing the easy things. Maybe you’re no good after all, maybe you’ll never be able to figure any of this out. Maybe you should just give up.”"
If fucking *Scott Alexander*, possibly the smartest guy I know of, who is constantly genuinely trying to get to the truth and do the right thing, feels that way, well, fuck it. This is just dumb. I thought maybe I felt that way because…well, because they were right. But there's *no way* that *you* should feel that way all the time, so why should I? Fuck that.
Thank you, genuinely, for being you and allowing us to see who you are.
+1
This is a banger and your writing style is great. "My IRB Nightmare" righteous-anger vibes.
Also, typo: "I decided not to submit then)" should be "submit them)"
Thanks, fixed.
Holy nephrectomy, this is inspiring. How inspiring? Let's predict! https://manifold.markets/dreev/how-many-people-will-follow-scott-a
Seemingly we have saints who are patrons of kidney patients (there's a saint for everything!)
First, St. Benedict of Nursia (*the* St Benedict who founded the Benedictines) whose connection seems tenuous; it may have been (pace the British Association of Urological Surgeons) because a king went to Monte Cassino to be cured of bladder stones, or (pace a Catholic website) because his monastic rule was so harsh, the monks tried to poison his kidneys by giving him tainted food and drink:
https://www.baus.org.uk/museum/1416/st_benedict_germany
https://thecatholicgiftstore.com/products/st-benedict-kidney-disease-healing-medal-holy-prayercard
Second, St Marina of Antioch, the patroness of nephrology:
https://pubmed.ncbi.nlm.nih.gov/10213803/
"Saint virgin and martyr Marina (Margarita) of Antioch in Pisidia (255-270) is recognized as the patron saint of kidney sufferers and the protectress of nephrology. Beginning in the 13th century she heals in particular patients suffering from nephropathies, pregnant women having a difficult childbirth, barren women and sickly children. She protects the patients from every side effect and complication. Saint Marina is represented in hagiography as a victor, defeating the dragon Satan, holding a hammer or a cross and wearing a belt around her back in the area of kidneys. According to writers, artists and sculptors the belt is the perceivable means of Saint Marina for the miraculous recovery from and healing of kidney diseases. Therefore, kidney sufferers and pregnant women put belts upon her relics for blessing and then wore them. From the Middle Ages and Renaissance and up to the contemporary period Saint Marina (Margarita) was considered the patron saint of kidney sufferers. Justifiably she is recognized by the modern medical world as the protectress of nephrology."
> This request didn’t get communicated to the surgeon and he told me anyway - but luckily everything did go well.
Perhaps the surgeon actually did receive the request, and violated it only because the recipient lived.
***
In countries where it is harder to sue hospitals than it is in the US, are decisions like UCSF's re: OCD less common?
***
Do any kidney-transplanting hospitals publish their full list of medical conditions which rule out a potential donor, either due to risk to the donor from the surgery, or risk to the recipient from a potentially subpar kidney? I would appreciate seeing one.
> Perhaps the surgeon actually did receive the request, and violated it only because the recipient lived.
I suppose the game theoretical problem is ameliorated because no one (?) donates kidneys more than once, so there's never a chance to figure out an individual doctor's pattern of behavior.
I knew someone with 3 kidneys, at least they said so, but google says there are only 100 cases globally so now I am suspicious. But possibly one of them could donate 2 times.
Good kidney, bad kidney, ... ugly kidney?
Brachos is a 🔥 mesechta
The Linear No-Threshold Hypothesis of radiation says that every milliSievert increases your cancer risk. It does not. Humans cope and even seem to thrive with a background level of radiation. Prof Richard A. Muller (the Physics for Future Presidents guy) has thoroughly debunked LNT. That the NIH supports it is further evidence that it is nonsense.
I think there are two things going on:
1. Without saying outright that I trust the NIH more than I trust some person who is "the Physics For Future Presidents guy", I don't trust the Physics For Future Presidents guy *so much* more that I will totally ignore the NIH's view and not even consider it at all.
2. 100 mSv has been empirically demonstrated to increase cancer risk, so if there's a threshold, it's there or lower. The CT I was worried about was 30 mSv. So to not worry about the CT, you would have to claim both that NIH is wrong and there is a threshold, and also that the threshold is definitely between 100 mSv and 30 mSv (and not, say, 10 mSV). I don't really see any evidence for that, so even if there is a threshold, I'm worried the test might fall above it.
That's quite funny -- both points.
What characterizes the countries with the highest per capita rates of living-donor kidney donation?
(Should those rates be adjusted for average age? For the probability that a potential donation will find a recipient? For anything else?)
The probability calculation of 1/660 doesn't seem at all correct to me. Every Sievert, you say, raises your risk of dying of cancer by 5%. But that's raising it from *whatever the current rate is*, which is... okay, a quick google says that cancer mortality in men is something like 200/100,000. So 30 milliSieverts would raise your risk by a total of 200/100,000 * 1/660, which is more like 1/330,000. (Or, I guess, raises your cancer risk by 1/110,000).
Came here to make a similar point.The linked article says "5% excess risk of death from cancer" and then has citations I can't reasonably follow; I can't tell whether that should be understood as (5% excess risk of death)(from cancer) [i.e. the cancer risk amounts to 5% increase in all-cause mortality] or (5% excess risk of) (death from cancer).
More glaringly, Scott writes:
"the risk of dying from the screening exam was 1/660. ... I regret to inform you she might be right. ... a 30 mS dose increases death risk about one part in 660."
Two very different statements! Does the scan have a 0.15% chance of leading to your death, or does it increase your odds of dying by 0.15%? The former seems crazily high, but contextually it's being compared to the risk of surgery, where the figures really are about the risk of the procedure killing you.
Anyway, Scott, if you see this, congratulations and good on you - just want to make sure you're not unnecessarily making kidney donation sound scarier!
Huh. I admit I didn't look super closely at the citation last night -- I looked a bit at them this morning and they are hard to follow, though I *think* they might actually mean that they do think a 30 mS dose could give a risk of dying of 1/660. What I mostly came away with is thinking that 30mS is a rather high dosage of radiation -- everything in the chart in the article is much less than that. (Also I came away with the idea that... no one really knows, actually.)
And yes, I forgot to say, congratulations Scott and I think that's really great!
Inside of you there is one kidney
> You don’t need to worry about not having a kidney when a friend or family member needs one. When you donate, you can give the organ bank the names of up to five friends or family members who you’re worried might end up in this situation. In exchange for your donation, they will make sure those people get to the top of the list if they ever need a transplant themselves.
This was certainly news to me, and makes me feel better about the whole thing, but doesn't the fact remain that your own kidney is much likelier to be a better match for a family member than some other kidney off the list?
I don't know. It's true that your kidney (because of genetic relation) is much better than average. But it might not be better than the best kidney available to the organ bank with hundreds of kidneys available. (I don't understand how this works well enough to be sure it works like this). It also seems like in some cases (eg spouse, relative with different blood type), your kidney wouldn't work at all, and the bank would be a better alternative (though usually the bank would let you make some kind of more direct trade).
I also wonder (1) what are the odds that they will actually "make sure those people get to the top of the list"; is there any accountability for this promise? and (2) is there any way for me to pay somebody with a blank space to write my name? (We could call this "The Taylor Swift trade".)
also (3) what about the lost optionality? It'd suck if your True Soulmate only comes into your life after you've made your list, or if someone on your list dies for unrelated reasons. Really they should just give you a fungible "Good for 1 kidney" token (which you could then trade on the open market because it isn't itself an organ!). (Plus, then maybe they could offer 0.9 tokens for a slightly-substandard kidney. )
I was also wondering about this. (Also about the incentives it would create if your list of names is freely editable.)
Presumably that would be illegal, but I would also think it would be much easier to get away with.
Great post Scott! Lots of love!
I found this post somewhere in my newsletter, and i was surprised that anyone would give precious part of the body to a stranger.
I have kidney disease (they dont work anymore to be honest), located in Europe - and here i never heard about 'random' donors.
Moreover, i personally never asked (and probably will not ask in the future) my friends or family for organ donor. Im overwhelmed about idea asking anyone for something that big and important.
Congrats, you make 30+yrs old man to cry like a baby :)
I really wish you everything best and i admire what you did.
You don't mention where in Europe, but depending on country, it might make sense that you haven't heard of undirected donations — they're illegal in France, for example. I am duly furious about this.
I was just going to say I wouldn’t be the tiniest bit surprised if they were illegal for no reasonable reason.
I thought about donating in Germany, but they are also illegal here for some reason (I blame Catholics), luckily I could also probably donate in the UK if I ever want.
Interesting. I can kind of see the logic for that.
France also bans paternity testing, which is very disturbing.
If this estimate of increased risk assumes the linear no-threshold theory (LNT) -- and a quick look at the cited paper suggests it does -- it's nonsense. Read Jack Devanney's substack on nuclear power, where you will find demolitions of the LNT theory.
See my footnote 2 and discussions above.
My usual admiration for Scott. Even higher than usual if possible. Glad he is alive, was considering open a manifold market: Is Scott in hospital? - Had hoped for an even better reason to be there. And feared for worse - The beginning freaked me out: "As I left the Uber, I saw with horror ..." One of my few wishes left is: May I die before Scott does.
Cheers for NOTA! To keep up the pressure, I shall keep my organs for now. (From an MRI I assume the one kidney is not fine enough to donate, and the fine one I intend to keep.)
Excellent post.
It took me a while to register that Scott was giving an accurate account of what was going on in his life rather than offering a thought experiment or a short story.
I AM a naive reader* and accept most the authors may throw at me. Scott's fictional texts signal early enough what they are + while his life stories are so true, it may hurt. Most his posts are non-fiction (esp. if one discounts the bay-area-parties, we know now). And after such a long break from posting, I was ready to expect a story involving a hospital. The Q of my YL has gone up much by reading Scott. So I care.
*I assume nearly all are. To do better, eventually, reading Bryan Caplan may help me: a) Caplan writes some libertarian stuff, I buy it all. b) Caplan gets into a discussion and lets the other side explain their position. I buy this now 90%. c) Caplan writes why he still disagrees with them; I buy 70%, d) They get one last say: Now I am kinda undecided and have to make up my own mind. ;) Right now at stage b) https://betonit.substack.com/p/sehon-responds-on-socialism
I wonder whether a policy to give a tax deduction rather than tax credits for kidney donation could receive less political opposition. Because it seems the main concern opponents of compensation for kidney donation have is that poor people will donate kidneys for financial reasons in a way that seems morally icky. Whereas with a deduction, due to the existence of the standard deduction, the financial incentives would become active at some level of income while not influencing the behavior of people poorer than that, right? Does anybody more familiar with US taxation and organ donation policy know if there's some number at which such a deduction could be set to alleviate the US kidney shortage while not influencing the behavior of the poorest, say, 1/3 of Americans toward kidney donation?
It seems unfair that the wealthy people who donate would get $100,000 while the poor donors get nothing.
Paying them is bad and not paying them is also bad? You just can't win!
The strategy to win here is to just not be poor in the presence of an ACX commentator talking about morality.
This sounds snide, but also makes no sense.
I think paying them the same amount is good. Another person thinks it's bad.
It's like reading two comments on abortion and observing, "Abortion is bad, but banning abortion is bad. You can't win!" Such is life on controversial issues.
I think in many cases it's the same people.
“It is a far, far better thing that I do, than I have ever done; it is a far, far better rest that I go to than I have ever known.” --Kidney Carton
Take this compliment, you dashing devil with your apposite pun, you!
I happen to live very near the "castle" and aside from a one week event for college students when they first bought it, it seems like they haven't actually run any conferences there yet over the last two years, but have continued to rent other venues for retreats and so forth since.
Old buildings can be money holes. I suspect, though don't know, that there are either transportation issues (there's a year+ long road closure on one of the main routes there) or maintenance issues that have prevented it from being used for any conferences as of yet. It's kind of a red flag to me that Oxford University owned it but then sold it as they didn't think it was financially feasible to hold on to. Though to be honest I'm glad it's back in university-associated hands rather than as a private building, as the university owns the rest of the adjacent land. It's a lovely area.
It's in Oxford, which is nice if you're a person living in Oxford, or attending Oxford University, or a professor there.
If you want to attract Business People and International Interested Persons, then London is always going to be a much bigger and better draw (same over here with Dublin versus the rest of the country). Easier to get to for most people, has the infrastructure and associated supports and other companies, entities, state and private organisations, and is just the first place someone would think of, rather than trying to get to a nice little historical village outside of Oxford.
I'm fully expecting it to be a money pit and ending up sold off again in a few years. Reading the defences of the decision to buy it, it seems to me to come down to (1) we had a shit-ton of money and no idea what to spend it on and (2) one particular guy was pushing hard for it and seems to have swayed opinion.
Again, I don't think they're bad people, just people of a certain socio-economic class who don't necessarily realise how their actions will look to the general public. Same as Just Stop Oil having a vegan-catered banquet in a (former?) church premises with accompanying harpist laid on - why did people laugh and cheer on the disruption? Because they're working-class/lower middle-class people inconvenienced by the protests blocking the roads when they're trying to get to work, and they certainly aren't going to be serenaded by classical harpists at work:
https://www.youtube.com/watch?v=gd_tNpyShrY
And of course they look exactly as you'd expect (boots with summer dress) and are humourless: "must be paid by the Daily Mail!"
They want to solve global climate change by stopping oil, which will be easy-peasy to do, everyone just stop using oil - but getting a few balloons down from the ceiling is a very difficult problem, so hard!
https://www.youtube.com/watch?v=8P0bN4Tmel0
I know a retreat held there in the last month, that someone I know attended
Purely anecdotal evidence: I was at a workshop in the castle this month, and the same organizers had done one event there already and were planning to do two(?) more.
Also, a nitpick, as far as I understood, CEA didn't technically buy lent it for the next 100 years.
Kudos to you. Though I am suspicious your evil voice will learn to adapt to the new circumstances, perhaps encroaching on your good voice's turf in the right kidney, or, if the "left" part is important, perhaps claim your left lung?
I looked pretty throughly into kidney donation and even signed up for the first level screening but I ended up chickening out. However, I heard at one point that a screening question that’s commonly asked during the kidney donation process is “do you donate blood?” and I realized it was silly that don’t, given that I was likely eligible and that it’s a much lower risk but also life saving intervention. So I started donating blood and I encourage anyone who’s not quite comfortable with donating a kidney to try donating blood or platelets! The FDA has recently changed screening guidelines so that some previously deferred groups in the US (including gay men who haven’t had a new partner recently and people who have lived in the UK) are now eligible to donate.
+1
Donating blood is really easy, has almost no downsides, and the ones that it has are small (eg avoid exercise for the next 12 hours or so).
Agreed!
Small note: the article you cite from Tom Ash was actually written by Josh Morrison and Thomas Kelly, according to the preface of the post.
Thanks for writing this. I donated as well, and found the experience to be a weirdly effective self-signal. I try to do various altruistic things, from donating money to choosing high-impact jobs, but good signals are costly, and these just aren’t all that costly for me.
That’s probably a bit counter intuitive - what could be most costly than my literal time and resources? That’s all I have! Here’s my thinking: after donations, I still live a life of extreme wealth and comfort compared to the average human, so the opportunity costs of donation are kinda trivial (like, maybe if I didn’t donate, I would buy the new VR headset that just came out, but I don’t suffer greatly because I haven’t done so). As for my job choices, these have coincidentally (suspiciously I might add, in my moments of doubt) been things I find challenging and interesting and rewarding in and of themselves. On top of that, there’s the point you mention that lots of my preferred ways to do good aren’t actually seen as good at all by plenty of critics (and, like, many everyday people too). I’m somewhat prone to imposter syndrome, and it’s easy for me to doubt my own motivations and impact on the world.
Donating a kidney was not only a costly signal of my values (the right balance of costly - annoying but still worth doing), but it also carried a lot of metaphorical resonance for me, since I have a typical secular worldview in which I am nothing over and above my body. Now, when I look at my body in the mirror, I’ll always notice and be reminded that it has a couple faint scars from the time I literally changed it - changed myself - to try to help someone else in a small way. It serves as a reminder that I can do annoying things because I value them, and I can literally change who I am in the process.
This reinforces my identity as someone who wants to do good things for the world, and serves as a healthy reassurance when self-doubt creeps in. So, for strictly non-altruistic reasons related to my general self-image and the narratives I want to tell about my life, I rate kidney donation pretty highly. All the altruism stuff is a great bonus on top of that 😉
So... doesn't that make you biased against viewpoints that would suggest that you shouldn't have donated?
Probably, but I don’t see how that’s relevant — the goal of this comment is just to share an unexpected benefit, not to tell anyone it’s the right choice for them on net.
It doesn't seem like a benefit, though. It seems like it pushes you further down the wrong path and makes it harder for you to turn back.
I guess we have a difference in values - benefit *for me* in that case :)
"Also from my spicy [version of the "Effective Altruism As A Tower Of Assumptions"] essay:
Q: All possible forms of assistance, financial and otherwise, just make recipients worse off, for extremely complicated reasons. There are literally no exceptions to this. I promise I’m not just looking for an excuse not to do charity, I would love to do charity, it’s just that literally every form of charity is counterproductive. Weird, isn’t it?
A: Even kidney donation?"
Now that's what I call putting your kidney where your mouth is! (don't eat your kidney)
Really wish I could "like" these comments so that I can tell someone they're hilarious without diluting the discussion with a contentless comment.
Anyway, that was really funny :)
That sounds offal.
What kind of a technological advance do we need to just start printing out artificial kidneys for anyone who needs one?
Castles need TLC as well, such as repointing stonework as needed, and weeding small trees and other foliage growing near or on walls, or even retiling roofs assuming the place isn't a complete roofless wreck. So the group who bought the castle also deserve some credit for maintaining it, assuming they do so adequately, for the benefit of future generations.
The "In polls" link seems to be wrong or broken?
> Self-modifying into a person who can act boldly without social permission is a more general solution and has many other advantages. But the long version involves living a full life of accumulating moral wisdom, and the short version starts with removing guardrails that are there for good reasons.
I was vaguely uncomfortable reading part IV - the one about the castles and the fuzzies and the utilons - and I guess this footnote made it clearer why.
Ten years ago, you wrote that "in all situations, the government of Raikoth will take the normatively correct action." In those ten years of life, having accumulated the moral wisdom that you did, would you say you've gotten closer to embodying these words - not in the sense of *knowing* the correct action, not even in the sense of *actually doing* it, but in the *knowing that you know* sense?
My impression is that 2023!Scott is, if anything, more reticent about this stuff than ever. This is a problem when Guardian opinion columnists are constantly whispering dread outside-view incantations in his ear, demanding that he give up his left kidney, and generally holding his sense of satisfaction hostage. That seems even worse than the state of nature, which is getting fuzzies from Meaningful Human Connections™. Those, at least, are fake in an obvious way.
(not that I'm saying it was wrong to donate the kidney; just that this post is pretty depressing, like watching someone fill out taxes, except it's not even a morality tax like the GWWC pledge, it's a tax on *having a morality*.)
(also, there's two part IVs.)
https://healthsystem.osumc.edu/pteduc/docs/WhyDoINeedMoreThanOneIV.pdf
What do you mean by saying Guardian columnists are demanding he give up his kidney and holding his satisfaction hostage? I see that as his inner sense of shame and scrupulosity. I agree it is a sad post - I wish he did not need to take such drastic steps to feel worthy.
Why hasn’t someone already solved the LDNT debate once and for all with a large RCT on rats? IRBs won’t let them?
Hi. CT scans have been around now since the 80s as well.
The whole brouhaha started with Brenner's paper in the AJR in 2001, which was modeled on radiation from Hiroshima and Nagasaki, which itself is not a fair modeling example, because the radiation profile is different and you can't just extapolate the risk from 1000mSv to 1 mSv (CT scan would be between 1-10 mSv). Until then, no one talked about diagnostic imaging and radiation risk.
So the burden of proof lies on those who say that radiation from diagnostic imaging (< 50mSv one time dose) increases risk of cancer, not the other way around. There is no data showing this in adults. Those who believe in the hypothesis have moved to children, where if at all (and no one has accounted for reverse causation), for every 10,000 CT scans of the brain, there is one increased brain cancer risk, that's it.
Modeling is just that, modeling. All of the references below say "There is no evidence that low-level radiation from medical imaging causes harm and below 50-100 mSv of exposure, the risks are too small to be observed or non-existent".
1. Amis Stephen. Radiology 2011: 261: 5
2. Position Statement of the Health Physics Society, Jan 2020
3. American Association of Physicists in Medicine – position statement Oct 2018 - https://www.aapm.org/org/policies/details.asp?type=PP&id=439
4. Hendee William R. Radiology 2012: 264: 312
Unlike with so many other medical interventions, where our follow-up data is in the range of a few years (statins is now 35 years), with X-rays we have good solid long term data. Remember that from the 20s till almost the 90s, patients were also exposed to barium studies, IVU studies, where the radiation was in the same range sometimes as CT scans. Some observational study from the NHS or from the Scandinavian countries that track all their patients would have shown some causation. But there is nothing.
Casually bringing up your disdain for journalists in the absence of an occasion to criticize them creates more heat than light and annoys my NYT-reading fiancée
Being annoyed is a sad waste of an opportunity to reflect on bias.
hating on the castle-haters wasn't exactly endearing, either. Using up that "feels good" budget of doing a tangible thing, I suppose!
I think you're being serious but your mention of the NYT makes me wonder. (You do know what they did to him, right?)
This still gets my hackles up. Let me fumblingly try to articulate and explore why I feel this way, in a way that hopefully sounds valid.
-----
Let's imagine for a second that this was written by someone other than Scott, someone who I haven't spent years reading, and whose thoughts I don't understand as well.
The text of this article is "I donated my kidney". The message, partly stated but mostly implied, is "You should do so too." (With caveats of "I'm not telling you to do this, just giving you social permission to do it if you were already inclined.")
Most people trying to get you to do something this drastic and unusual don't have your best interests at heart. They stand to benefit in some way or another. That in and of itself is a pretty big barrier to convincing people.
How can someone benefit from kidney donation to a random stranger? They don't have to benefit directly. If they have a value system that thinks your actions improve (their conception of) the world, they'll usually try to argue you into it anyway.
Does this actually improve the world? Probably, at least to some extent. Does that extent justify the health risks?
Scott's a doctor, I'm not. With my limited knowledge, my heuristics are, generally speaking, "Keep things related to body, health, and diet as close to natural as possible, doing medical interventions only when necessary, or where the problems are accumulating enough to justify it." I assume that the redundancy in my kidneys is there for a good reason and am inclined to keep it.
This has had some benefits to me: I have a friend who, during a rough time of his life, went deep down a psychiatry rabbit hole, culminating in a breakdown that left him dependent on benzos and unable to work. While we were talking about his issues, I told him my heuristic, and he admitted that it was probably a good one. That's not a knock on the people that need medications—some people really do need it—but the point is even for something like medication, I usually have to convince myself to use it, and err on the side of avoiding it.
So you say the risks are small. Given that I'm this risk-averse, is your definition of "small" the same as mine? Probably not. The weird testicle thing alone would probably be enough to put me off. I have no idea what could cause that, how hard it is to treat, or what kind of long-term damage it could do.
And that's even assuming you're telling the truth. Since you already have a motivation to argue the side that convinces me to do this—look how many QALYs you can bring to the world by convincing me!—you might have a motivation to lie. Or if not lie, then at least do the subtle not-lies that might convince me anyway, like tell a one-sided story; cherry-pick bad evidence; or ignore, neglect to mention, or handwave away some of the risks.
These concerns aren't totally theoretical. Elizabeth of Aceso Under Glass has recently started fighting EA vegan advocates for engaging in exactly these kinds of tactics: https://acesounderglass.com/2023/09/28/ea-vegan-advocacy-is-not-truthseeking-and-its-everyones-problem/
https://acesounderglass.com/2023/05/30/change-my-mind-veganism-entails-trade-offs-and-health-is-one-of-the-axes/
Then I start wondering: hang on, how far will this guy take this?
"You should do this" seems to imply a moral norm: you're a good person if you do this, you're a bad person if you're not. Is he on the onramp to a moral crusade? We've seen a lot of those in politics lately. He's got all those caveats to his message, but does he mean them? If he does mean them, then for how long? Will he still be as forgiving when kidney donation is commonplace or even expected among his friends or ingroup?
Is he trying to make him and his friends look good, to have him and his friends accepted as the morally virtuous subculture, at my expense?
With that gut reaction firmly in place, I start probing my moral philosophies, against both the weaker explicit message and the stronger potential one. I start thinking of bodily autonomy, and abortion: does this line of thinking imply that it's morally correct for women to bring their babies to term at the expense of their own (similarly likely minor-to-moderate) health risks? If good people are morally obligated to give their own kidney, how much else of their life and literal bodies are they morally obligated to give as well? How much marginal risk or pain is one person supposed to take for a marginal improvement of someone else's life?
And then I come into the comments and argue.
-----
Okay, taking a step back: this isn't quite how I reacted to this article.
The big reason for that is because, like I said in the beginning, I've been reading Scott for years. I know, to some degree, how he thinks about medicine. I've read some of his writing on moral obligations, which makes me think he's being honest about mostly just sharing his story and giving people who were already on the fence social permission to go ahead and do it.
https://slatestarcodex.com/2014/12/19/nobody-is-perfect-everything-is-commensurable/
Because of that, my actual reaction to this article is that it shifted my opinion very slightly, enough to maybe freak out a bit less in the unlikely case that a friend of mine decides to randomly donate a kidney.
I would probably still freak out a little bit, and this article is very far from enough to convince me to do it myself. My heuristics are too strong, and my self-awareness in my lack of knowledge too great. Figuring out whether I even want to do this is not a way I want to spend my time, energy, or health, so I default to "no".
-----
So why am I rambling about this here? Because I expect that this kind of thought process happens in a lot of people that have a negative gut reaction to EA. I expect it happens almost instantly, and likely subconsciously.
A lot of EA writing is a Rorschach Test.
The gut reaction you have to something like this depends a lot on your past experiences, how much you trust the author, your exposure to Effective Altruism, and how often you've had people try to pull one over on you at your expense. These all feed into your personality, heuristics, and priors. That's why you get reactions ranging from "Nope, you're a crazy liar" to "Interesting, tell me more".
IMO, the only way to reach the defensive ones is to advocate for more common-sense, lower-risk actions whose benefits are more easily explained and apply across different moral systems. I've written about this here:
https://www.kronopath.com/blog/how-load-bearing-is-your-ideology/
Though I understand that's probably not who you wrote this article for.
-----
Anyway I'm glad it went well for you and I'm sure whoever got it from you was immensely grateful.
(And sorry for taking a soapbox to this personal story. It just got the gears turning.)
Despite my ramble above, I can't help but think of another blogger I loved to read, Shamus Young, who was diagnosed with end stage kidney failure in 2022 and died three months later. Actions like yours could have made a difference in his case.
https://www.shamusyoung.com/
https://www.shamusyoung.com/twentysidedtale/?p=54058
https://www.shamusyoung.com/twentysidedtale/?p=54513
Here's to your continued health.
While I don’t agree, I think this is a beautifully written and valuable comment.
Excellent comment, best of the bunch, thank you for rambling your way through it!
I agree with some of your points, I've definitely noticed that sort of negative gut reaction from some of my more suspicious friends and your explanation makes their reaction make a lot more sense to me. I used to be very all-in EA, but while I admire Scott immensely for having the courage to take a step like this, it's also given me the same sort of gut reaction - the reaction of how far should we take this, and how much against our common sense should we go?
Thanks for your comment, definitely helped my thinking a lot!
I love this comment and think you're right on.
Another relevant Scott piece is this one: https://slatestarcodex.com/2018/11/16/the-economic-perspective-on-moral-standards/
> I think of society setting the targets for “good person” a lot like a CEO setting the targets for “good vacuum salesman”. If they’re attainable and linked to incentives – like praise, honor, and the right to feel proud of yourself – then they’ll make people put in an extra effort so they can end up in the “good person” category.
I find this viewpoint disturbing and unhealthy
I don't get the "you should do it too" vibe from Scott's article, he did point out that kidney donations are not very effective as far as EA goes. As a person who was kind of on the fence on the decision, I feel like reading this article both increased and decreased my desire to donate (learning that you can put 5 friends and family on the priority list was a big plus). Getting support for the tax credit idea is probably far more impactful than warming up individuals to the idea of donating themselves.
To add another note to this comment:
- Veganism has a big lobby which creeps into EA, organ donations don't have that, so I don't think it's fair to bunch them up.
- That there are other articles by EAs criticizing EA practices, and no notable criticism of kidney donations in EA, is a stronger signal that kidney donations are actually a good thing than if there were no articles at all.
I applaud your donation, but as for making one myself I have a deep sense of DO NOT WANT.
Welcome back !
Seeing you gone for so long had me turning into a conspiracy theorist.
I'm just glad this wasn't a case of "OpenAI had invented AGI, and brought Scott in for 1 month long NDA access."
That's pretty close to my partner's guess, that Scott was currently "in the boss fight with the AGI".
Great to hear about the different kind of fight. Scott's success in winning is that he picks the right battles. Literally.
> as low as an 0.5 - 1% ...
Not sure which way the utilitarian calculation goes. The additional ACX time, either now or 25 hence, is probably still fairly valuable, e.g., David Friedman is still cranking out interesting stuff while old. But not sure how to quickly compare intellectual output to additional QALYs now.
Huh, and here I wasn't sure if I was just imagining "haven't seemed to get many SSC emails lately, what's up with that?" Worth the wait - always really enjoy posts about your own life. Skin in the game and all that, now you've Got The Receipts in a very concrete way. Someday if we get excellent generative AI for shows, it'd be cool to dramatize this essay as The Alexander Kidney. Or I'll try to recast you as the hero in Angel Beats!
...which segues into, I can't really imagine spontaneously donating a kidney to a __complete__ stranger? Maybe a family member, probably a friend, definitely a SO, some sort of handwavey Inner Ring calculus involved. Bad experiences with involuntary donations make me react really poorly to bodily-autonomy-integrity violations, no matter the utils involved. (And that was just for hair!) OTOH, being on the standard organ-donor registry that everyone signs up for with their driver's license - yes, of course, it's not like I'll be around to miss them at that point. I think I read somewhere on your old blog that such organ donations went down as cars got safer, actually, and It's A Problem...?
Description of the actual process and surgery...retroactively reassures me I made a correct decision to cancel [other elective surgery], even if in theory there's financial reimbursement available. I do think there's definitely some above-replacement Happy Price which would change my mind - $100k is several years of wages for me, that's Not Nothing, money is fungible - but other illegible costs like time and logistical hassle can't be "repaid". Wonder if there's any potential in streamlining the approval process - does it actually need to be several months? (I also don't understand why homeopathic levels of mental illness would be disqualifying, unless it was of a variety particularly prone to driving rash decisions?)
Scott, as a kidney donor
A: Welcome to the club!
B: Thank you so much for writing this. This piece is going to reach a ton of people, make waves, cause a bunch of new donations, and probably save far more people's lives than your actual donation did.
I've chatted with Dylan Matthews about this, but there's an *extra* massive reason for public influencers to donate their kidneys. Dylan has probably, no joke, caused hundreds or thousands of extra donations via his articles and advocacy. The actual impact of his specific kidney is a rounding error to the attention he's drawn. I suspect that with your platform, the impact your donation will make is at least 100x the typical donation.
So thank you for donating, and thanks for being vocal about it. And thanks for supporting the Modify NOTA campaign!
If anyone is interested, I wrote about my decision to donate here: https://www.infinitescroll.us/p/infinite-scroll-special-edition-kidney. I'm happy to answer any questions anyone may have.
Thanks! Wish I had seen your article earlier, might have put me above the threshold of "this is common enough to feel normal now" a little earlier.
First off: congratulations Scott! A tremendous thing to do, and I admire your speaking openly about it and encouraging others to do the same.
The CT scan/risk of cancer struck me as unbelievable! I do try to avoid CT scans on patients younger than 40, but I always put the risk as closer to 0.05% - 0.1% per scan rather than nearly 0.5% as your girlfriend calculated. I did a deep dive into this once for pregnant women and I remember the 5% per Sievert thing coming up there (risk to the fetus of childhood cancers, if Mum gets a CT.) Are we definitely sure this is for adults? I did a quick Google just now and clicked on the usual suspects - Scientific American says "a single CT scan increases the average patient's risk of developing a fatal tumor from 20 to 20.05 percent." WebMD: "the chance of getting a fatal cancer from any one CT scan is about 1 in 2,000." Memorial Sloan Kettering: "0.05 percent, or less than one in 2,000 — of possibly developing a future cancer."
Obviously I would love to see a deep dive into this topic!
A multiphase abdominal CT is 30 mSv, compared to 7 for a standard chest CT, so if the upper end of your number is right for the average CT, my number is approximately right for the multiphase abdominal that I was considering.
Interesting. Multiphase is getting you up to whole body combined CT/PET scan levels.
Even if it’s 1/500 (0.2%) this is overwhelming the operative risk and should probably be emphasised much more in the consent process.
1. Kudos on the Vox journalist line, made me genuinely giggle uncontrollably at work.
2. Kind of strange, I've been involved with EA for awhile, donated a lot of my (meager) income to charity, and, given the opportunity, would happily take some risks for altruistic purposes. But I still haven't got past kidney donation to a stranger sounding absolutely ridiculous. You can do something just bloody horrible, slightly dangerous (possibly including a bunch of risks you're not taking into account), not at all fun/ exciting, with lower altruistic cost-effectiveness than working and donating to an effective charity... If the effectiveness calculations looked incredible, I would be at least persuaded that it's a morally good idea, but as it is, it feels more like the kind of socially contagious masochism that EA should be trying to avoid.
3. When I was travelling in Northeast China near the Korea border, I spoke to a cleaner in a cheap hotel. He asked me: "Where are you from?" "The UK", "Ah, can you sell kidneys in the UK?", "No, there might be a black market, but it's illegal", "Ah". Then the conversation ended.
I think people really differ on how comfortable they are with different risks - I'm planning to donate my kidney, but I just can't bear to part with much of my income. I value the comfort and security I can buy much more highly than the health risks of donation. Also, kidney donation is way more fun to me than work. It's weird, you get to go to different places (I learned a lot about which jobs in the area don't require drug testing, courtesy of some guys who sounded like they needed that). I am kind of hoping my work fires me for trying to take time off to donate, because then I will gleefully tell that story in every interview. (Somehow I don't want to quit or be fired, but I don't want to have this job.)
What do you infer from anecdote 3 about why the question was asked?
That is such a random and bizarre comment that I don't think you can infer anything!
I inferred that he was either considering selling a kidney, or that he was suffering from seller's remorse, torturing himself about the idea that he hadn't got the best deal.
Well, first of all, congratulations! There's kidney disease in my family, and yes my cousin died several years down the line after a transplant, so it doesn't mean you can live your normal lifespan. But without it you'd probably be dead, so better a few more years of life than nothing, right?
"They found 34 extra cases of ESRD (end-stage renal disease, the most severe form of kidney disease) per 10,000 donors who were related to their recipients, compared to 15 cases per 10,000 for donors who weren’t (the difference wasn’t statistically significant, but I think it’s still correct for unrelated donors to use the unrelated donor number)."
I imagine if you're donating to a relative, that means there's already a higher risk of kidney disease in the family, so the risk would be increased. As for the risk for donors overall, that may well be because if you have two working kidneys, and then down the line one of them conks out, the other can pick up the slack. But if you only have one working kidney and it starts to fail, then you develop the problems faster and worse.
But it truly was a charitable deed so well done!
I'll only take this one little pop at the Brits, so the castle was the cheapest option? Perhaps, but did they factor in (1) the bad visuals this would produce, so hampering their efficacy because this will turn off the public from donating to them and (2) how do other organisations manage? Are they all out there renting/buying castles, or do they somehow manage to find some kind of conference centre that won't rip them off? I have a feeling that the British EAs had too high an expectation for what they would find acceptable in a conference centre, and coming across a castle they may have found ways to justify "wouldn't it be really cool if we had our own castle?" Boring, bland, beige big room in a hotel may not be anywhere near as glamorous, but I find it difficult to believe it would be that hugely more expensive. I do feel there has been some creative accounting of the "sure, it *seems* like a huge expenditure, but if you take it that over the next twenty years we'll be hiring conference centres at a cost of £X,000 each time, and you multiply £X,000 times Y conferences to get a total cost of £Z00,000 then by comparison, a one-time purchase comes off cheaper".
Yes, you're not paying £X,000 a go for each conference, but now you have a castle to maintain and upkeep, and that's gonna cost.
"I thought I was going to be able to do a good deed that I’d been fantasizing about for years, and some jerk administrator torpedoed my dreams because I had once, long ago, had mild mental health issues."
That's hard. But on the other hand, you live in America. The most litigious nation in the world. Where cities sue car manufacturers because their cars are too easy to steal (Chicago, Baltimore and New York bringing lawsuits against Kia and Hyundai). I'm tempted to say "well in a sane country, you'd blame the criminals for stealing, instead of blaming people for not making their products too difficult to steal" but that would be unkind?
You could swear up, down and sideways that you really want to do this and you're a grown and sane adult and you are doing this of your own free will, but they have no guarantee that five weeks after the operation they won't get a solicitor's letter looking for zillions in damages because they took advantage of a mentally vulnerable individual. Hence, the magic therapy requirement: it's covering their backsides in case of legal action so they can point to "we required him to go to therapy to make sure he wasn't crazy", not for your or any other potential donors' welfare.
> I'm tempted to say "well in a sane country, you'd blame the criminals for stealing, instead of blaming people for not making their products too difficult to steal" but that would be unkind?
I friend of mine blew up at me for saying almost exactly this. I could see this getting generalized in very weird ways.
I suppose yes, if all other automobile manufacturers have incorporated anti-theft devices and Kia and Hyundai haven't, then they do bear some responsibility.
But cities going "We have too many criminals who can roam freely and do as they like, this is *your* fault" doesn't make the car manufacturers look bad, it makes the state of life in your city look bad.
I think the major divergence of viewpoints here is that Scott knows of the type of people who altruistically donate kidneys, whereas I know of the type of people who made a living out of insurance fraud (hence the lawsuits) 😀
There's an ambulance chaser law firm in my town which makes a speciality out of "Dear me, you tell me you had a trip and fall on badly maintained pavements? As did seven other members of your family? Tsk, tsk, let us sue the local council for their neglect of repairing the streets and road surfaces!"
Well, maybe the local council could afford to repair the streets if they weren't being sued every ten minutes by you guys, just saying?
More likely, they'd never repair them without the lawsuits prompting them.
I was going to say exactly this! They're not concerned with your well-being in some "paternalistic" way, they're avoiding being sued. Most likely, some organ donation program in the state was once sued for that reason and lost, and now the malpractice insurance companies all require this protocol. As a diagnostic, I notice that a program in NYC doesn't have this requirement, and that's likely because nobody has won such a suit in New York state.
I imagine they also didn't give any therapy recommendations for much the same reason Scott doesn't give medical advice/recommendations to queries on here.
If they suggested "do such-and-such a therapy for so many weeks", that'd be catnip for the lawyers. "Why did you recommend my client do this particular therapy? Are you a licenced psychiatrist?" "Well, no, but - " "Aha! Manipulating a vulnerable person! That's another zillion in damages we claim!"
I don't disagree with you at all; this is certainly the proximal reason why the bad system I described in the post exists.
"But on the other hand, you live in America. The most litigious nation in the world."
Close! https://www.scribd.com/document/391259964/The-Most-Litigious-Countries-in-the-World says, (in the teaser before the paywall):
"Here’s a list of countries with the highest number of lawyers per capita:
1. U.S. 1 lawyer for every 300 people
2. Brazil: 1 lawyer for every 326 people
3. New Zealand: 1 lawyer for every 391 people
4. Spain: 1 lawyer for every 395 people
5. UK: 1 lawyer for every 401 people
6. Italy: 1 lawyer for every 488 people
7. Germany: 1 lawyer for every 593 people
8. France: 1 lawyer for every 1,403 people
While it’s true that the U.S. has a large number of lawsuits crowding its courts each year, it barely cracks the Top 5 of most litigious countries in the world. In his book, “Exploring Global Landscapes of Litigation,” Christian Wollschlager notes that the litigation rates per 1,000 people shows that European nations top the list of the world’s most litigious countries.
Here is a list of the top 5 most litigious countries by capita:
1. Germany: 123.2/1,000
2. Sweden: 111.2/1,000
3. Israel: 96.8/1,000
4. Austria: 95.9/1,000
5. U.S.: 74.5/1,000"
Typo: "have still" -> "still have"
I've noticed dozens of typos in Scott's posts over the years but have always felt awkward about bringing them up so I never have. (This is not at all a criticism of his writing; nor do I really care about typos. I'm just the type to pick up on tiny aberrations like that.) I'd feel less weird about it if there were a way to submit GitHub-like pull requests on writing so I could just submit a patch that could easily be merged.
There is - you just comment like Curious mathematician did.
You might find it interesting that some sites do, or at least one that I know of - the online web serial site Royal Road has almost exactly this system where you highlight stuff, make an edit and then there’s a ready way to paste it in the comments with auto formatting.
Dear Scott,
it was interesting to read about the low risks of kidney donation as well as the thought process you went through. What I am sceptical about is wether paying people for kidney donations would actually be the best systemic solution for dealing with kidney failure. I don’t have numbers on the following and you are probably much better at doing the research on that, but as far as I know most kidney failure is related to other diseases (like diabetes II or hypertension) the genesis if which is closely related to lifestyle/ living conditions and can well be prevented. Do wouldn’t the best systemic intervention be to create living conditions that allow people of all classes to make healthy choices without additional expenses? (like modifying taxes on certain foods or forbidding them once they have been proven to be harmful - like high fructose corn syrup - or reorganising supermarkets and advertisement in a way that doesn’t ruin lives for the profit of certain industries…) Or even investing more money on alternative treatments for infectious diseases that would allow to use nephrotoxic antibiotics less often?
Those are just some naïve thoughts of a European, but I would be curious your prognosis on those interventions vs. paid kidney donations.
Kind regards!
Slow chronic kidney function decline is almost universal with aging, as is true of other chronic cardiometabolic problems. How bad it gets, and how early it gets bad, is highly multifactorial and can’t be cleanly ascribed to lifestyle. There is a complex interplay among different aspects of the metabolic syndrome, as well as their best-practice treatments, such that the causality arrows don’t always fall in the places and orientations you might assume. The subset of severe kidney failures that occurs in young people with really obvious lifestyle risk factors certainly exists, and is very visible and salient if you are looking for it. I question whether health policymaking should treat it as the conceptual starting point for thinking about kidney failure management.
I think from the examples you suggest that you aren’t yourself very prone to a punitive gatekeeping mindset, and I don’t want to impute one to you, but I don’t trust broad policy strategy to be developed without one if pursued along these lines. Rather than little tax nudges or occasional judicious ingredient regulations, I foresee non-judicious ingredient regulations (ie, proliferating sweeping bans: as an American who is now German, food and drug regulation strikes me as already overzealous here; the 180 degree opposite of wrong is not always right) as well as draconian treatment eligibility crackdowns, which to your credit you don’t recommend but which seem to me fairly likely results of a broad shift toward this kind of approach. I don’t even think you’re wrong. I just worry about it.
Well, I do think that prevention is one of the best strategies (one if the cheapest, as well, long term). I’m not sure what you find overly zealous about food regulations in Germany and think that the health of the German population would also benefit of higher taxes on sugar and lower ones on vegetables. Also healthy and cheap meals in school canteens as well as public canteens offering meals at a reasonable price might be a way to go. Generally, improving living conditions and wealth of the people on the lower end of the spectrum (maybe through raise of minimum wage) has an impact on improving their long term health along with it.
You don't think it is also overzealous in the US?
on food, the US is a weird mix of over- and under-regulation (remember that funny article about the bucatini shortage that turned out to come down to regulators obsessing over the precise composition of an imported pasta recipe? but also, having lived in both US and EU and eaten ad lib there with sharply differentiable n=1 outcomes, i suspect there really are a few odd ~toxic ingredients and practices in the US that demonstrably could just be eliminated with a different policy apparatus. do i trust anyone to fix it? no lol but still)
on drugs, US is most definitely over-regulated, but at least you can order baby aspirin on the effing internet there. like. you don’t even know.
This feels like trying to solve school shootings by making everyone a good person who would never kill anyone else, as opposed to realistic solutions like security guards or gun control. It's obviously the right solution, but nobody knows how to do it and we shouldn't let it hold back things that might actually work.
"Make everyone eat healthy and exercise" isn't a solution so much as a fantasy. The government (and other sectors of society) have been trying really hard to do that for decades, and if it was possible to succeed I would have expected to see it by now.
Security guards and gun control are effective measures to prevent school shootings, but so are structures that assure low-threshold contacts for students with troubles with their family or with bullying and while the first might be necessary, the second addresses the problem at an earlier level. On a similar side „making everyone eat healthy and exercise“ doesn’t work if we try to force people to do stuff without changing existing structures. People who have to struggle for their existence tend to chose the path of least resistance, so if the path if least resistance is fast food and cans, they will chose that. However, if we create a path if least resistance that allows people to be healthier on the side, it’s not like they will object. You can improve people‘s health by how you design cities, by making it easy to access structures of every day life (stores, schools, work) on foot or by bike. In Europe there’s another good example in the field of organ donation. In Austria your organs can be used after your brain death by default, unless you disagree, whereas in Germany you have to actively declare that they can be used. Obviously more people are organ donors in Austria, because to actively disagree, you have to mentally engage with the topic and that’s uncomfortable, so not disagreeing is the path of least resistance.
As someone who started looking into thuisbankier reading Mathews’ article and was then beset by akrasia, I want to give this another go. Does Waitlist Zero have counterparts in Europe (specifically the Netherlands)? Their contact form asks for a US address.
Sorry, it's a great question but I don't know the answer.
Wow, amazed at the quality of writing here. that one blew me away. i had no idea, but have known many in my life who both donated and received kidneys... and i think i knew one whose left one was stolen. But as a non-Dr, and with a RN Nurse sister, I can say this for others, "We don't trust u." Flat out. No trust. Nada. Not for giving blood anymore and not for anything while alive. Sure, harvest everything you can once I am brain-dead, but stay the F away from me until then. Yes, it's that bad. I've been here almost 70 years, and seen shit I still can't believe happen in field hospitals to the best America the world can offer. And now ya got your AI to cut with, so I'm out just from that point alone. You should be really aware about what goes on in the medical-device industrial-complex before you let one of those things tear into ya. FDA? ha. They have better inspections here in Nepal, even with our ragtag group of clipboards and ink stamps. Hate to break ur bubble, but great writing, nonetheless!
Care to elaborate about WHY you don't want to donate any blood or tissue? You made a lot of insinuations but gave no specifics.
Not really, I don't care to discuss, and I didn't bring this up, the author did, but since I am always complaining about people not talking to each other, let me try communicate my truth online again. (This is not gunna go well folks.) Gamereg, I DID say WHY: TRUST. Simple human fear, based on experiences. That's it. And very little reassurances coming from the medical community (in the west) to belay that fear.
However, first responders, top notch. Nurses and medical techs, brilliant. Old school Dr. from an old school university, well, there we begin to have issues. Private MD strapped for cash, or worried about bottom line, more problems. Corporate greed in the Insurance-Medical Industrial Complex, even bigger problems. Keep going up the money chain, and it gets progressively worse by the time you get to Wall Street.
Some might say the above is not a logical reasons to NOT donate blood or kidneys. Yet some just say FU to that. And then many are just wary, confused or ill-informed when entering those big gaping hospital doors. I would think it would be the medical community's responsibility to ease those fears and distrust, somehow. I'd give them a failing F grade in that regard, after the Covid fiasco. And after the Aids fiasco, and all the fiascos between those two black swan events. Hell, throw in earthquake responses I've been part of, and throw in WAR as well, as it's hell and I know no medic can be held responsible for that, but bloody hell, triage in a war zone is not FDA approved. But WAR is approved, so there is that.
That's a long answer for someone I don't know and was never properly introduced to; I guess it's the same at your end. I hope you know me a bit better now, and for whatever reason you chose to reply above, thank you for that and I hope this answers your query.
Reading this reminds me of Shamus Young's blood pressure/kidney problem posts, which he died from last year.
https://www.shamusyoung.com/twentysidedtale/?p=52745
These are the recipients.
Wow...I'd read a lot of his backlog at some point but didn't know he had died.
> No matter how contrarian you pretend to be, deep down it’s hard to make your emotions track what you know is right and not what the rest of the world is telling you.
This sounds to me like it was written by someone with an very different internal experience than me.
Do you actually feel like you “know what’s right”?
My experience is I often have conflicting notions of what is or isn’t right, and “the rest of the world” isn’t telling me one thing or another - it’s a confusing mass of shouting from different groups of loud, confident, intelligent sounding people all explaining why the other groups are stupid and evil.
Sometimes, I’ll see someone do a thing, or be a certain way, and think, wow, that seems right and good and noble, and I want to imitate that way of being. But to me this is like a non deterministic Turing machine that cannot find the truth (it takes too long!) but is sometimes capaable of recognizing specific instances of it.
I have a pretty clear notion that donating a kidney to a stranger is not right, while the rest of the world probably sees it as a good thing.
Not challenging, but definitely curious:
- what do you mean by not right? Not right for you, like you don’t want to? Not right for anyone? But what does that feel like?
- what do you mean by “rest of the world”? Are you imagining some aggregate function over the emotions of some set of people? Which aggregate function - something like mean or sum? And which people? Anyone alive today? Adults?
I get the impression that lots of people use the same kind of language you are using, but these claims don’t map to my experience, because “it is wrong” for me is a thought that usually translates it to emotion like anger or contempt towards a thought of a person doing that thing.
The notion of “the rest of the world” used to make sense to me as a concept into i tried looking directly at the concept in a way that tried to add some modicum of precision, and the concept itself just collapsed.
I guess it feels, or looks, like watching someone make a mistake.
Definitely no anger or contempt - I suspect this is coming from thinking of a very specific kind of wrongness.
When you see someone not standing up for himself, that is clearly wrong, but it seems more likely to trigger sadness and frustration. That's more the type of wrongness I meant.
By "rest of the world" I meant what most people alive in the world would think.
If you want to save multiple lives and not discover that falling GFR in older age is twice as bad with one kidney (it is, obviously!), donate blood and get on the bone marrow database. You really can make a huge difference. I'm alive today because a delightful young man in Germany gave me some bone marrow stem cells. Yes, that makes me biased, but it's a no-brainer! I used to be a blood donor back in the UK, but here in Canada they didn't want my blood as I'd lived in the UK in the early 1980s - risk of mad cow disease. Moo! They wouldn't take it anyway, now, having leukemia.
I'm also banned from blood donation because of Ireland in the early 2000s and mad cow disease. Somehow never came up with the organ donation. Good luck with the leukemia.
I lived in the UK in the early 1980s and was banned from blood donation, but they recently (earlier in 2023) relaxed this restriction in the US. I'm still in the debating-long-and-hard stage for kidney donation, but I'm signed up to give blood for the first time tomorrow.
Ooh, I'll have to look into this!
Quick update, I went to the blood donor center, made sure to tell them I'd lived in the UK, and finally gave blood! I'm not 100% sure what applies to 1980s UK applies to 2000s Ireland, but I imagine it's similar. With the exception of my vein being pricked with a needle, the process was completely painless.
> (obviously saints can do good things without needing psychological permission first, but not everyone has to be in that category, and I found it easier to get the psychological permission than to self-modify into a saint.)
“Assume a virtue, if you have it not.
That monster, custom, who all sense doth eat,
Of habits devil, is angel yet in this,
That to the use of actions fair and good
He likewise gives a frock or livery
That aptly is put on. Refrain tonight,
And that shall lend a kind of easiness
To the next abstinence; the next more easy;
For use almost can change the stamp of nature.”
― Hamlet, William Shakespeare
Having said that, there's one thing that the article never went into that you'd kind of think would be front and center in any talk about transplants: rejection and management thereof. If you give someone a new kidney but at the same time condemn them to a lifetime of immunocompromise, how much have you really improved their quality of life? The more you look at transplants, the more they look like a really terrible thing that we only do because it's the least-bad option available at the moment, the kind of thing that Dr. McCoy would scoff at and accuse us of being barbarians living in the Dark Ages for practicing.
Out of curiosity, (I genuinely don't know and would be interested in finding out if anyone's looked at this,) has there been any research done on questions along the lines of "would it be more effective to donate a kidney and help one recipient, but we know it works, or to fund stem cell research into own-organ cloning which could end up solving the problem for everyone but is currently hypothetical?"
1. Everyone knows we need a systemic solution, and everyone knows what that solution will eventually have to be: financial compensation for kidney donors.
Over the longer term, I'm highly optimistic about bioengineered human-compatible kidneys grown in pigs.
2. I was getting worried when Scott didn't post much over the last few weeks. Now I know why! And it's a very commendable reason. Thank you Scott for donating!
Personally, I've donated blood and sperm (and I'm due for another blood donation next week). I thought about kidney donation but decided it would take too much time away from my research, and I'm worried about its negative effects on me.
For what it's worth, I know two people who have recently gone through the process. One dropped out late in the process, and the other successfully donated their kidney. This is in the last ~6 months.
The one that dropped out felt very pressured by friends and family, and realized they were not in a good life place to take the time off of work. I think they were scared as well.
The one who donated seemed to have a fine time and was back at work well before expected.
Both reported that a charity was going to pay their expenses, including lost wages. For the one that went through with it, that seems to have worked exactly as advertised.
Kind of related. I’ve always thought that “opt-out” (instead of opt-in) organ donation on driver’s licenses for example, would help increase the supply of organs including kidneys. But when I’ve talked to healthcare economists about it, they say it’s a bad idea because it would bankrupt the health care system given the high cost of these surgeries and the aftercare. Thoughts?
That objection doesn't make sense to me - each kidney donation saves money over the counterfactual dialysis alternative.
I have heard healthcare economists say opt-out doesn't seem to help much in practice because most cadaveric organ donations involve careful negotiation with the family of motorcycle crash victims with the specific box they check being only one input into the family's (and legal system's) decision making process. I don't understand the details here well enough to overcome my common-sense confusion about this not being a bigger deal.
I guess it’s more about who is paying in each case. Is it the government or private insurers?
Obviously the castle people could have found cheaper, drabber options, and guests would've been fine with it. I doubt there's a warehouse shortage. It seems EA folks haven't learned much from FTX.
"Hi Senator. Please attend our conference. You'll have to sleep in a bunk bed with the President of Belgium, and there's only one bathroom for fifty people, but please come anyway, it's the right thing to do." Sure, that'll go over well.
More relevantly, you can't accuse EA of not learning anything from FTX because this happened before FTX.
There are decent hotels near industrial areas. Moreover, if I had a lot of money, I would be impressed by the sheer rationality of a simple and cheap meeting room near an area with unassuming hotels (of course taking into account safety, convenience, etc.).
My accusation was not at the castle-dwellers, but at the fact that someone like you can't see how bad and ostentatious a castle looks for the EA movement. A pinnacle of public FTX disgust was the contradiction between the video of SBF signaling his EA bona fides by showing off the meager car he drives while later revelations showed his ostentatious mansion.
Though, since you bring them up, if they are still residing at the castle and not realizing how bad that looks, then my criticism expands.
"Though, since you bring them up, if they are still residing at the castle and not realizing how bad that looks, then my criticism expands."
Continuing to use a castle they own is not the same as buying a castle. If they sell the castle now, people will continue to point to that time and EA organization bought a castle, only now they will cite the fact that the castle was sold as proof that the arguments for buying the castle were bullshit. At the same time, they would presumably lose money on the sale.
It's hyper-rational to admit a mistake and align with long-term goals, even if there are short-term costs.
If the way they differentiate themselves to investors is hyper-rationality, then they can signal that by saying, "We over-rationalized a childish indulgence but we have aligned our investments more rationally and instituted new processes to avoid similar mistakes."
By God, there's a lot of taxpayers in a lot of countries who wouldn't mind seeing the President of Belgium and a senator or similar from our proud nation having to bunk in together.
Anyway - welcome, player, to the multiplayer strategy RPG "Doing Good? or Doing Great!", hereafter referred to as DGDG.
You start off as a starry-eyed idealist of high education and socio-economic class, stuffed with unearned privilege which you are eager to transmute into benefitting the lower types less fortunate than you. Along the way, the choices you make will affect your progress towards one of the two endings:
(1) Doing Good? (for others)
Ultimate Achievement Level: Poor But Honest 😇
(2) Doing Great! (for yourself)
Ultimate Achievement Level: Swankin' Wid Da Big Boyz 🤑
Your progress is measured by your repute (not to be confused with compute, but still important even if it doesn't have a sexy new word) level, on the scale of OPTICS. The higher your repute level, the more you can get away with - but be careful! It is possible to gain NEGATIVE, as well as POSITIVE, repute from the decisions you make, the actions you take, and the consequences of your choices.
Okay, I see you have already completed Act I.
Final Level Achievements:
(1) The Peacock (badge awarded for ostentatious display such as purchase of large, expensive, historic manor house in an agreeable setting in the English near-countryside)
(2) Name Change (reducing confusion or increasing it? both? that's the beauty of it!)
(3) Changing Horses In Mid-Stream (when you pivot from doing what your original aims were said to be, to something completely different)
Congratulations, player, you have now unlocked Act 2 - INSTITUTIONAL BLOAT!
Optics Bar reading:
You have advanced three notches towards À LA LANTERNE. (Warning: if you reach this limit on the Optics Bar, you will be permanently locked out of ending "Doing Good?")
Unlocking this new act enables you to take on side-quests such as:
(A) They Flew To Bruges
(B) Because I'm Worth It
(C) We Always Travel First Class At This Level
(D) The Poor You Will Have With You Always, That's Why I'm Bored Of Them
(E) But We Have To Make A Reservation For Le Manoir aux Quat'Saisons Restaurant, The President of Belgium Expects It
(F) Who Will Roast My Langoustines? (related to side quest E above):
https://www.tripadvisor.ie/ShowUserReviews-g1096521-d752551-r880929124-Le_Manoir_aux_Quat_Saisons_Restaurant-Great_Milton_Oxfordshire_England.html
"We enjoyed the taster meal on the first night especially the Ballantine of duck liver and the roasted langoustines."
Completion of any three of the above gains you the awards "The People's Flag Is Faintest Pink" and "Swanking (We're Swankin' In The Name Of EA)".
There's an implicit Peter Singer argument in here somewhere. I only have one kidney to give, so by giving it to a stranger, I can no longer give it to a family member.
That's why there's the condition that you donating puts you and 5 family members right at the top of the organ donor list. Plus, you may not be a match for family members, so being at the top of a larger list may actually be a better outcome than saving yours just in case.
I didn't know that, thanks!
Very honest post. I hope you get the likes from people you were looking for by donating your kidney!
Can you try getting the statistics for Israel to get a better idea of the risks? My understanding is that in Israel the situation is reversed, with ~90% of kidney donations being altruistic (unrelated to the patient) so the statistics will be a lot less messy.
IIRC, Israel changed their policy a number of years ago, because there was a lot of religious resistance. The new rule was that in the event of two people needing teh same organ, the one who was previously an organ donor received it. Rates of organ donors skyrocketed.
In Germany it is actually illegal to donate a kidney to a stranger while you're alive. (You can do it when you're dead, but obviously then your kidney won't be as good.) While you're alive, unless the recipient is a relative or at least something like your fiancee, apparently the law considers the dastardly danger of the ever-menacing terrible organ trade mafia too great to allow you to save the DALYs of a fellow human.
Are you sure? I did some research after reading this post, it does not sound like it should be forbidden per se: https://www.organspende-info.de/lebendorganspende/nierenlebendspende/
Wikipedia¹ says:
> Das Spenden eines Organs, das sich nicht wieder bilden kann, ist zu Lebzeiten für Verwandte ersten oder zweiten Grades, Ehegatten, eingetragene Lebenspartner, Verlobte oder Personen, die dem Spender in persönlicher Verbundenheit nahe stehen, möglich.
And this article² makes a statement to allow for altruistic donations, so it seems like Daniel Böttger is unfortunately right.
¹: https://de.wikipedia.org/wiki/Organspende#Deutschland
²: https://www.dgfn.eu/stellungnahmen-details/stellungnahme-cross-over-lebendnierenspende.html
Darn, I was really hopeful there.
For future reference (mainly for me, without the wiki detour), this is the relevant part of transplantation law, and it's quite clear.
https://www.gesetze-im-internet.de/tpg/__8.html
For a moment, I thought that the "special personal relationship" permissive rule could be bent ... - but it definitely rules out any case where you don't know the person you donate to at all, as well as anonymous donation.
Here's hoping someone will listen to these doctors' public statements (I found sth similar published by the Federal Ministry of Health (BMG) in October 2021).
Yeah, it's a shame.
Eff tax breaks, why not help the people that need it more? Organ donation for get out of jail cards. Not for murder and rape. But surely we can find it out heart to forgive those people who downloaded a bunch of songs on Napster or something. Next time someone wants to make an argument about how they made a terrible error in judgement and learned from it, there is a way to directly demonstrate that. Hell, kidneys for green cards might just be the kind of proposal both sides might just accept.
I'll grant that 30mS increases risk by 1/660, but that's not the same thing as a 1/660 risk of dying. If your risk of dying of cancer is, say 1% baseline, increasing that by 1/660 is like an extra 1/66000 chance of dying (ballparking here). Am I missing something here?
I mean absolute risk; it literally causes a 1/660 chance of death. That increases your relative chance of death by . . . some amount, depending on what it was before, I haven't calculated that.
I posted this in another thread here, but I'm pretty sure the 5% figure is relative risk, not absolute. This site:
https://www.imagewisely.org/Imaging-Modalities/Computed-Tomography/How-to-Understand-and-Communicate-Radiation-Risk
explicitly lists the 5% figure as a relative risk which, by my calculations, corresponds to a 1/4650 absolute risk. By all means let me know if that's a bad source, but IMO the math just doesn't make sense if you interpret it as absolute. Google says there are 80 million CT scans per year in the US. If 1/660 of those wound up with cancer then CT scans alone would account for ~10% of all cancer in the country. That's like 1/4 of the total from smoking. There's just no way.
There's also the issue that you're comparing the radiation risk directly to the surgical risk without taking into account that death from cancer would happen many years into the future while death from surgery would be immediate. You'd have to convert both into QALYs lost in which case the risk from surgery would be clearly higher.
According to this, CT scans can be estimated to cause about 2% of annual cancer in the US.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996147/?utm_source=substack&utm_medium=email
The problem with calculating multiplying the number of CT scans with the risk is that a very large number of them are performed on old people or otherwise people whose life expectancy is too low for them to be able to develop a cancer attributable to it.
Wouldn't it make sense for total organ donation to be the default execution method? Lesser criminals could donate a kidney in exchange for reduced sentence.
Really really really bad perverse incentives, ahoy!
Elaborate? There's already more than enough prisoners for kidney demand to be saturated, and I'm not sure how individuals who need other organs would be able to increase executions enough to significantly increase their own chance of getting an organ.
The perverse incentives would be encouraging executions.
"A perverse incentive is an incentive that has an unintended and undesirable result that is contrary to the intentions of its designers."
Do you think it's undesirable to execute a probable violent criminal to save the lives of several people?
The undesirable result would be more executions. At least, that's undesirable for people who are against executions.
I guess if you're against executions even of prisoners in a way that's net life-saving. I wish I had such a positive view of the world that something like that is what counts as "Really really really bad perverse incentives".
I know this is beside the point of the article, but since you're an MD in the field I was curious about your use of the word "schizophrenic" in this article. It seemed like you were using it to refer to multiple personality disorder, which I thought was distinct. I've been pedantically, obnoxiously, correcting this in other writing and ask not questioning if I've been wrong all this time!
You're right that they're distinct; I believe Scott was using "schizophrenic" here to mean generally disordered/without logical flow, which is characteristic of schizophrenic speech.
I agree I was using it colloquially and incorrectly.
The blood donation centers assert that donating a pint of blood saves three lives; this seems... overstated... though as brazen propaganda it certainly worked on me. Do you have a more plausible estimate?
Back in the 1980s Evanston Hospital pulled one on me that would probably be considered unethical these days: while I was donating the nurse let a little girl hug me, sobbing, and thank me for saving her mother's life. This is no fair... It did, of course, work; I've been donating at least quarterly since.
How did that work? Was the girl acting or did she somehow believe you saved her mother's life?
Ah, the narrative presented was that her mother had bled heavily that morning while giving birth to this girl's little brother, and that without us - donors - she would have died. She seemed to believe that *my* blood was going to save her mother's life, but that was misdirection on the hospital's part, I think.
"I asked if they could do the kidney scan with an MRI (non-radioactive) instead of a CT."
Radioactivity and ionizing radiation are related but not identical concepts. Radioactivity is a type of ionizing radiation, but ionizing radiation can be generated in other ways besides radioactivity.
CT scans don't use radioactivity but do use ionizing radiation. Nuclear medicine tests use radioactivity. MRI uses neither.
Hey Scott, have you looked at New Zealand's reform?
NZ Initiative, a sort of free market-y think tank advocated for a model where donors are compensated for lost wages (previously donors were only compensated for a small fraction of their prior earnings).
https://www.nzinitiative.org.nz/reports-and-media/reports/compensation-for-live-donors/
It inspired the Compensation for Live Organ Donors Act, which states "live organ donors who are eligible will be paid regular weekly earnings from the day of their surgery and for up to 12 weeks while they are recovering."
https://www.health.govt.nz/system/files/documents/publications/compensation-for-live-organ-donors-information-pack-may21.pdf
As far as solutions go, 'Compensation' as opposed to a reward/incentive, feels like a less 'ick' framing.
Thanks! In the US some donors can also be compensated for missed wages while they recover, as of 2017. I don't think this has helped too much, although it might be too early to tell.
Coincidentally enough, in today's NYT crossword puzzle, the clue for 10 Down was "Givers of priceless gifts", and the answer was "ORGANDONORS". Well done, Scott!
Probably shouldn’t nitpick this but I’m not seeing this for October 27 or 26.
I've seen discrepancies before - it seems we get the NYT puzzles (in our local daily paper) some time after they first appear. (Canadian prairies, for what it's worth.)
Oh yeah. I know what you mean. I used to work them on a physical newspaper in the before times. I'd get them in the Saint Paul Pioneer Press (Saint Paul, MN is in southern Canada ;-) )
In that paper they were running about 6 weeks behind the NYTs!
I ran the Twin Cities Marathon twice - it's a very happy thing to crest the last hill and see the Capitol dome gleaming past the finish line.
No doubt it is a relief. I live about a mile south of Summit Avenue. Just where the long uphill from the Mississippi begins to level and descend to the Capitol. I usually cheer the runners on from that point. But this year the marathon was cancelled due to the temperature being much too high. :(
Summit Avenue, if I am remembering correctly, is aptly named. I belive the long climb starts around Mile 19, and continues to c. Mile 25.5.
I had been told to watch for the glorious sight of the golden dome of the Capitol, and that the run was downhill from there. As it turned out, there's a false summit partway up, complete with the shiny dome of a church.
Nevertheless, it was a tremendous experience.
*****
Somewhat even farther off topic, how is life in the Twin Cities these days? We non-residents have heard horrid stories of rampant crime, mostly coinciding with the George Floyd riots and COVID. I hope things are not as bad as the media would make them out to be.
(This was the Sept 22 puzzle.)
So we're only five weeks behind here. That's not too bad. ;>)
Beautiful entry Scott. I donated for a selfish reason (to a family member, my dad) but still share most of the sentiment (and post-op hiccups!). It really resonated in me. Congratulations and my best and sincere wishes to you.
Does donating an organ make one ineligible to later donate blood?
If so, one would have to weigh the relative benefits of each.
I asked the plasma donation place when I was planning on donating, there's temporary deferral in the immediate aftermath (it is a surgery, after all), but nothing long term.
Does anyone know if there is an equivalent to the thing about giving 5 family members names for priority kidney donations when you live in the UK? I may have missed it somewhere but I can't seem to see it on the information online, and you'd think it would be something they'd make very visible if it was an option.
My kidney mentor was very helpful because she told me to set up my voicemail. I think I would have disappeared into the kidney abyss if I hadn't done that.
Also, sometimes you really remember the salary differences in EA - even if I took a full four unpaid weeks off (currently planning on two, probably paid, weeks) - I would not get close to losing $5000.
I will never set up voicemail.
Do you seriously not have it? That's much more surprising to me than donating a kidney... why?
Can't answer for Scott, but I never set up mine. There's a risk that people will start leaving me voicemails! And worse. They might expect me to listen to them!
Do you also not have email? or text messaging?
My mind is blown, mostly because I didn't realize or think that this was a live option.
Because I also didn't believe it, I looked into it. The 1/660 number seems OOM correct.
From Radiation Dose Associated With Common Computed Tomography Examinations and the Associated Lifetime Attributable Risk of Cancer by Rebecca Smith-Bindman, et al, they estimate you would require 498 40yo male patients receiving a multiphase abdomen-pelvis CT to give one of them radiation-induced cancer. While this radiation-induced cancer is not necessarily mortal, it is probably >10% lethal (some of the other looking into it I did suggests ~50%), so that number sounds right-ish.
(Note that this is lifetime risk, so the probability goes *down* the older you get, because there's less time for the cancer to appear.)
you really are a saint! (I lost my paternal grandfather early to kidney failure, my father is on dialysis and my uncle was too for years until his wife donated him her kidney. both me and my sister also have slowly failing kidneys so I know how valuable a functional kidney is) I hope if there is an afterlife you go to the best section of it.
by the way here in the netherlands what worked great was to make being an organ donor the default option rather than not being an organ donor. turns out the vast majority is just too lazy to change the status.
As a male your lifetime risk of developing cancer is around one in two. A 1/220 additional risk modifies this to become 0.5045. So the difference is fairly miniscule. The 1/10,000 risk of death from the operation is a probability and so is not comparable to the excess risk value.
I don't understand why a 1/10,000 risk of death and a 1/660 chance of death aren't comparable.
(they're not perfectly interchangable because one is per operation, ie a specific day, and the other is per lifetime and has to be discounted for a death at age 80 not being much worse than what you'd get otherwise, but besides that I don't understand).
I also don't think that comparing it to lifetime risk of cancer anyway is useful context. Which would you prefer: a 1% absolute risk increase of dying from cancer, or a 1% absolute risk increase of getting eaten by a giant squid? The 1% cancer represents a 2% relative risk increase, and the 1% squid represents a 999999999x risk increase, but they seem about equally bad to me - I've got an extra 1% absolute mortality risk either way.
Yes but I suppose what you measured doesn't depend on what I prefer.
I am assuming that the 1/220 risk is distributed over the entire lifetime. I think what you're assuming is that it measures the risk of developing cancer immediately after the scan, rather like the risk of dying due to the operation. I don't know for sure which view is correct, but I think my interpretation is the right one.
"I am assuming that the 1/220 risk is distributed over the entire lifetime." If it is distributed evenly over a lifespan (as a very, very, rough approximation), I think that comes out to half the QALYs lost that an instantaneous 1/220 risk would cause. To put it another way, the mean effect of a 1/220 risk, spread across one's remaining lifespan is (I think, if I have the math right) equivalent to an instantaneous 1/220 risk halfway through one's remaining lifespan.
Your methodology for calculating the risk from the radiation dose received in the screening exam is flawed. The thumbrule you quote is correct, but the risk from radiation exposure is not linear. Low doses are much less problematic than large ones, as the body has the ability to repair radiation damage up to a certain threshold.
Good for you for saving a life! According to the Talmud, you’ve saved an entire world! Why didn’t you meet with the kidney recipient though?
Modifying NOTA is brilliant and necessary. Reducing taxes for ten years seems like it only would incentivize middle class and rich people who pay taxes. This would cut out 50% of the potential donor pool. Why not just let Medicare pay donors; they’d still be saving money by not having to pay for dialysis treatment. I wrote about this years ago.
https://heshy.substack.com/p/resistance-to-new-ideas-kills-people
it would be a refundable tax credit, so if your taxes are less than the credit, you get a tax refund check for the difference. this may not be the ideal way to administer it but it would probably work fine; lots of low-income people already file taxes to get the EITC which works like this.
Well, what if he doesn't like the person? What if there's some sense of control, obligation, or regret on meeting the person?
Ok, I can see that as an argument for not meeting the recipient. But I know several organ donors who met their recipients and it was an amazing experience for all involved parties.
Wow, Scott! That's a wonderful thing you just did. It shall be accounted to you as righteousness!
Like many other commenters, I was speculating that maybe your wife just had a baby and that you were going to pop back in here with a "Hi everyone, meet Earendil Metatron Alexander!" I did not see a kidney donation coming.
Excellent, excellent, excellent. As an applied use of mild recurrent OCD and a comprehensive examination of voluntary kidney donation. Thanks for both.
Congrats on donating! I've bought specially branded t-shirts that say "I donated a kidney to a stranger and all I got was a stupid t-shirt" for people who have done that. I don't know if you're going to read comment #310, but let me know if you want one. From the people who have one, it's apparently a cross between funny and helpful to start conversations
I saw one person with one of those at Manifest! I'm socially nervous about wearing one but appreciate the offer.
The amount of bureaucratic friction placed between potential donor and donation sounds wildly disproportionate relative to risk, need, and reward. Sorry you had to go through that. Maybe just reforming the bureaucracy, with good rather than bad bioethics norms, will go along way toward pulling that % of donors up to 1-3%.
I think because it's adjacent to a lot of bad ideas and sets off people's "bad idea detector" in a way that doesn't turn out to be valid once you think it through.
Like if risky performance-enhancing drugs are legalized, then in competitive fields, taking on the risks of the drugs will be table stakes. Or, "if lots of people have an extra $10k a year in income, won't that just raise rents by $833 a month, to the point that people can only afford to live in San Francisco if they donate a kidney?". Or, "Won't this only appeal to desperately poor people, so we're using the poor as organ farmers?". They basically all boil down to "you don't want the compensation for donating an organ to become something that people depend on".
But there just aren't *that* many people on the waiting list in the grand scheme of things, so there'll likely never be enough kidney donor slots for it to become the sort of thing people do to just get by.
You'd almost want to scale the incentive based on number of willing donors versus remaining demand, which makes me realize I'm talking myself into a market for donated organs.
If you don't want people to make desperate decisions for money, the proper patch isn't banning specific forms of that, it's categorically eliminating poverty via Georgist LVT and UBI.
An under-regulated market for organs and tissues would have horrific risks due to the potential for outright theft, but we seem to have swung too far in the opposite direction. If compensating organ donors is to be permitted at all, how about simply using government fiat to set the price in dollars equal to the number of people currently waiting on a transplant? That sort of variability might help prevent exploitative business models from becoming entrenched, while incentivizing folks who want to get the best cash value for their bodily integrity to lobby for transnational cooperation.
I wonder if part of the unpopularity is that 'stranger donors' tend to be weird (see below, and WEIRD, see Joseph Heinrich), and that most people, if they have any exposure to the concept, is from the emotional torture porn/Will Smith vehicle Seven Pounds. Which isn't altruistic donation (he's doing it for redemption, to balance the scales), but is possibly the closest thing in mass media.
>Your brain uses the same emotional heuristics as everyone else’s.
No, I suspect that's not entirely true, or EA either would not exist or be wildly more popular. See below-
> I asked them what kind of therapy was indicated for mild OCD that’s been in remission for twenty years.
While I want to assume the professional psychiatrist knows more about OCD than I do, I'm... *unconvinced* that some noticeable degree of EA intuition isn't a variety of scrupulous OCD.
That isn't to say it's not real, or that they're not doing good, or there's not similar parallels in many ways, or that "wanting to do good" is a problem, etc etc. Try not to be unnecessarily uncharitable in reading me, okay? But the commonality of the intense empathy, intense desire to do good, generally-somewhat-and-sometimes-*really* radical unselfishness strikes me that indeed *no*, your emotional heuristics are clearly not the same. In some cases you go to lengths to, as you say, [remove those guardrails](https://www.astralcodexten.com/p/book-review-what-we-owe-the-future), but at least to some degree it seems innate.
Edit: My own (pointless, sidelines) take on the Castle Scenario is that buying a venue is not, in theory, a bad idea. That venue in particular clashes with the general "aesthetics-deficient" perception of EA, but more importantly for why it caused such a big stink, communication about it was awful and in the end they just wound up downgrading the EA Forum community section to get over it, which is not a great solution. Sort of a... "trust your betters" and "shut up, peons" vibe; a lot of unforced errors involving the communication and not just the actual purchase.
I think part of the problem is the admission "we had tons of money sloshing around and nothing better to spend it on, now that funding has dried up yeah we probably wouldn't do that again".
If you have so much dosh, are there really no secondary, tertiary, or further down the list charities you could donate to? Not even throw a few bob at the local Home for Blind Three-Legged Puppies?
It's not a good look to be an ostensible charity based on "doing good better" and then do things like this, when there are plenty of "this region has been hit by flood, drought and famine and we really could use some food, medical supplies, and housing aid" campaigns from other charities. Especially since it seems (though I could be getting this wrong) to be the brainchild of one guy who managed to swing the funding for his pet project of "why can't we have big, swishy, luxury centres like the ones I went to in Europe?" and then stepped back out of any commitments to be responsible for running or further funding the place.
The castle incident arguably isn't the most shocking thing about EA.
It is interesting, in a grotesque way, to read people who admit a willingness to kill (or at least watch die, or cripple with malnutrition) a certain number of humans in order to save (or make less discomforted) some larger number of chickens, or shrimp, etc. talking about "doing good better."
Yes, this exactly. It seems like scrupulosity to me - I just commented on that. I feel like it's an unhealthy way to treat guilt.
I do think a lot of EAs suffer from scrupulosity, but it's not universal. Maybe...70%?
FWIW, I am the sort of person who does not feel emotionally driven to help strangers at all, but the cold logic of EA calculations appeals to me.
My colleague Luke Semrau has written several articles arguing that there should be a kidney market. https://philpeople.org/profiles/luke-semrau. I think his work is good, despite the fact that utilitarianism is a false theory of morality (my main objection to EA enthusiasm).
> But I think about myself at age 20, a young philosophy major studying utilitarianism.
Heya Scott, I picked up Anna Karenina again this morning. I thought you might like to know that Bentham and Mill are name checked on page 8.
I wonder what the breakdown of the 100K on the kidney list is between people who had kidney failure through no fault of their own (non-fun sports/stupidity accident, genetic disease, autoimmune) vs. lifestyle choices like diabetes due to eating too many fudge rounds.
Does this factor into the altruism view - of potentially rewarding someone for bad decisions?
People who eat their way into kidney disease are less likely to get approved for a transplant, because they're more likely to continue the self-destructive behavior that got them in trouble in the first place. So whatever the underlying % of "deserving" people with kidney disease is, it's probably higher for approved recipients.
Thank you!
What's the ethical calculus on kidney donation vs bone marrow donation?
Good job Scott! I ran into logistical issues last time I started this process, but I now feel inspired to give it another go.
On the topic of the “castle” scandal. It’s important to know that there actually were two “castle” scandals, the second one being the ESPR chateau purchase which I made an EA-Forum post about:
https://forum.effectivealtruism.org/posts/pbe8x4AQDqftQoaT5/espr-should-return-the-ftx-funded-chateau
This post got a comment from a high-profile EA who was more involved in the project accusing me of spreading falsehoods which he promised he would write out later.
Naturally, since he was a high-profile EA much closer to this purchase and I’m just a random schmuck, a bunch of people heavily down-voted it, I lost karma/voting-power and the issue itself lost visibility and is now largely forgotten.
However, when the person later gave the promised list of falsehoods he put it in a swamped comment section without a link or mention of the original post which would’ve allowed people to compare. If they could’ve done so they would’ve seen that his comment didn’t point out any falsehoods at all and in fact spread a bunch of falsehoods about my post, the most egregious one I consider him vaguely implying I doxxed a bunch of people. (to this day I have trouble getting EA’s to reply to emails or accept my applications, and I have to wonder whether that’s because they think I’m a liar and a doxxer)
🤦♀️
To mangle a quotation from a countryman of mine: "To purchase one fancy-schmancy residence, EA, may be a misfortune; to purchase two, looks like carelessness".
This is the kind of thing people worry about with regard to the wider movement devolving into taking in one another's washing. Start off going "let's get a real sense of value for money when it comes to charitable donations instead of warm fuzzies", somehow end up "but we need big fancy stuff because we're just that important".
EVF as now is, or rather this Owen guy, seem to want to develop Wytham Abbey into the likes of Annaghmakerrig or Yaddo; an agreeable rustic retreat where you can mingle with the like-minded and be inspired to be creative. Very nice, but now you guys have become that exact administratively-bloated foundation that is more concerned with doling out the goodies to the very important people with the big titles at the head of the shooting gallery, instead of the original aims of the organisation, that was the very thing the EA movement started out critiquing.
Owen seems to have convinced everyone to fund that manor house purchase mainly because he was really impressed with the big, important places for big, important people that he had visited, and wanted a big, important place of their own to go and be big and important in.
I remain to be convinced this is actually a good idea.
> The last Guardian opinion columnist who must be defeated is the Guardian opinion columnist inside your own heart.
So true.
Can you elaborate more on the exact criteria for psychological conditions precluding you from donating your kidney? Clearly it's variable across institutions. Will having a mild mood disorder (which honestly doesn't affect my decision-making at all) on my record be a problem?
I wasn't given any more information than that I was rejected for OCD, but that they might reconsider if I did six months of therapy. I think every hospital has its own criteria.
Would you have to tell them about the mood disorder?
When I did the screening earlier this year I did have to (maybe I could lie). I was diagnosed after I filled out the form. but I can't donate until next year due to age restrictions. I'm a bit worried it'll be a problem next time.
If you really want to donate, I'd consider going to another transplant center and not mentioning it. Not sure, but I doubt that one transplant center would communicate confidential patient data to another.
I can't help but think of all the Effective Altruist Rabbis out there debating whether donating your left kidney was a good thing or not.
I am incredibly proud of you Scott, incredibly proud. I have been reading your blog ever since I was about 16, pretty much grew up on them and I am also a transplant recipient. I have to say, there has never been such a step change in my state of existence. Going in to the operating room I felt terrible, I then went under sweet anesthesia. When I woke up, I felt better, much better! I had just undergone a serious surgery and I was feeling better! The nurses wheeled me in to my mothers room. My mother, the visage of the Madonna was laying in her bed, having given birth to me a 2nd time. They held up the bag of golden urine, the water and waste trapped within me was gushing out. What happened in that operating room felt like a magical ritual. I am incredibly grateful for you that you helped someone experience what I experienced.
As for my story, I had kidney failure 1 year ago. I was on peritoneal dialysis (not hemo, where blood is taken out of the body, this is the usual one in the hospitals). To illustrate what this is like. There is a catheter attached to your abdomen. This catheter goes in through your abdominal wall, creating an open, oozing wound. I had huge psychological troubles with the catheter. It essentially made me feel disgusted with myself. I would carry it around attached to an elastic belt. Every breath I would take would lead to me noticing the catheter, noticing my disease. Noticing that I was a failed organism that had lost its ability to get rid of its waste.
The other end was connected to the dialysis machine, essentially a big pump. Every night you set up the machine at home. This involves connected about 10l of dialysis solution to the pump. During the night it pumps about 2l in to your abdomen every 1.5 hours or so and pumps it out. The waste in your blood diffuses in to the dialysate contained within your peritoneal cavity. This is then pumped out by the machine.
Sometimes, I would wake up with about 3-4l in my abdomen, belly bulging, the skin taut like a drum. The machine constantly kept me awake so there wasn't too much sleep anyway. It honestly was a limbo like experience waiting for my transplant. And despite all of this the dialysis only gets you about 5% of kidney filtration. That is it. You still suffer daily from nausea and fatigue. Not to mention the fluid restrictions, these were the worst.
Have you ever went 2 days without drinking any fluid? No water, no tea, no coke, nothing. Absolutely nothing. That was my existence. I had to double think about whether to eat a certain food if it had too much water. When you can't urinate, there is no where for the water to go. I also noticed how much of our social life revolved around drinking things.
So I tried to take power in some shape or form in to my own hands. Even after a transplant the future of the transplanted kidney is not certain. The prospect of returning back to dialysis haunts me, like the Sword of Damocles it hangs above, ever present. I want to vanquish this specter, I felt like I was robbed of a normal life by disease, so it was time to fight back. I have a mechanical engineering PhD, I was in automotive. I applied to all the Nephrology groups I could think of, for anything. I wanted to learn, I would do any technical thing for them in return for knowledge and experience in the field only. I did not want payment.
In the end, I had two offers. One was an internship at Erasmus Medical Centre on kidney Organoids. I believe that the eventual solution to the problem rests with lab grown organs. The other offer was from University Medical Centre in Utrecht. This was a 3 year post-doc position on developing an implantable bio-artificial kidney. I was in a dilemma for a while. I wanted a final solution and only the fully lab grown organ was that. But the future to that is uncertain. What if we really need the full embryological niche to build functional tissue? There are so many unknowns.
One night, I was walking back from my girlfriends house (15 minutes down the road walking) to my rental, to my machine. I was feeling horrible, the dialysis can't manage electrolytes very well, so sometimes I felt like my muscles weren't entirely there. Having left her house, without being able to sleep in the same bed (though she often came overnight to me, bless her). I finally resolved to start working. Not fundamental research, but hard engineering work which may yield an imperfect, but far better than what we have currently have, solution in the medium future. So I accepted Utrecht's offer.
I am still amazed that these guys took the risk, to accept a guy with no prior experience in the field. It really amazes me, I do feel indebted to them to some degree. Having started the project and seen how interdisciplinary one needs to be, I think indeed the most important thing is competence and drive. The former is to be proven, latter I am sure I have. I am writing this from my lab. I am currently setting up testing and device/prototype fabrication pipelines. I came in to lab 3 weeks after my transplant surgery which happened 30 May 2023. Its a huge project, and its requires all my efforts. But in the end, I will need more hands and minds.
There are parallel efforts happening in UCSF (your favorite place Scott!). But I have doubts that I shouldn't raise publicly under my own name. In any case Scott, if you want a chat about the project I would be honored (I could also tell you something about the transplant process from the transplantee side, my experience here was quiet interesting and similar in nature to yours!). In the end, for us publicity will be helpful. But more importantly, hands and minds.
I am 28. I hopefully have a long life ahead of me, and unfortunately, a lot of time to go back on dialysis again. The last thing I want is to hold my child with a catheter attached to me. Never again.
I always knew dialysis was bad, but this really drove it home. Thanks for writing.
really interested in hearing more about the doubts you have.
Awesome to see you've done this! I did the same about 11 months ago and feel awesome about it. Also partially motivated by the Vox article.
Good work! I have a vague memory of Dylan saying he thoughts about a dozen people had donated because of that article, but I'm hearing from enough people that I'm starting to suspect it must be more.
Thanks for that.
My husband has a rare genetic disorder that caused kidney failure in his 30s, and is currently on dialysis. We have a donor in the pipeline but no guarantees of anything, ever.
I would like to be an advocate for increasing the number of kidney transplants and was interested in the proposal to modify NOTA. Having "opt out" rather than "opt in" organ donation on driver's licenses and other IDs would also increase the number of deceased donor kidneys available.
I would appreciate connecting with your kidney mentor or anyone else interested in a coordinated effort to promote kidney donations.
Is it possible for you to donate at all, or are you afraid of pregnancy related complications?
You can click on Join The Coalition at https://www.modifynota.org/ and someone will get in touch with you by email.
(I think I heard that switching from opt-in to opt-out doesn't work as well as expected, but this is after five minutes of research, so if you know more, please let me know)
"Everything else I try to do, there’s a little voice inside of me which says “Maybe the haters are right, maybe you’re stupid, maybe you’re just doing the easy things. Maybe you’re no good after all, maybe you’ll never be able to figure any of this out. Maybe you should just give up.”"
This sentiment makes me want to scream. You’ve written things for years that many people have enjoyed, have found interesting enough to take into their own vocabularies and mental models and cite and link to years later. There are multiple thriving communities out there that are offshoots of your blog’s comment section. That you can’t trust the value of your own work - work that may be easy for you! but has not been done by anyone else! - because it can’t be measured in QALYs or DALYs or whatever is... frustrating, sad, and not surprising of course to anyone who’s been reading you for some time.
But letting the social circle and not-a-religion inside your head win is worse in some ways than the Guardian columnist, because you know the columnist isn’t you.
Very interesting story and analysis. One question my wife (coincidentally a Weill Cornell doctor) wondered: Is there an EA movement towards encouraging people to donate blood? That seems comparatively simple and costless, and there's a shortage right now.
I think it's not a very loud movement, but it's something that everyone agrees you should do.
Ironically, I can't donate blood myself because I lived in Ireland for a year when they had mad cow disease, and there's some ancient rule banning anyone in that category from ever donating blood. For some reason this doesn't apply to organ donations. I can't explain how or why any of these rules work, and I might be totally misunderstanding them, but I was rejected last time I tried.
It seems that particular eligibility restriction was recently removed: https://www.redcross.org/local/ohio/northern-ohio/about-us/news-and-events/news/donor-gives-after-deferral-lifted.html
It seems like it's possible to change those rules, in Germany they are now allowing men who have sex with men. Perhaps with UK/Ireland mad cow possibility exclusion no one really bothered checking if that rule still makes sense or is useful.
As mentioned below, that has been recently changed. The rationale, according to the Red Cross website, is this (tl; dr - they thought variant CJD - mad cow disease - could develop into CJD proper, there isn't a way to test for this in blood and it can be passed on via blood transfusion):
"In-Depth Discussion of Creutzfeld-Jakob Disease (CJD) and Blood Donation
CJD is a rare, progressive and fatal brain disorder that occurs in all parts of the world and has been known about for decades. CJD is different from variant CJD, the disease in humans thought to be associated with Mad Cow disease in the United Kingdom and elsewhere. There is no longer a deferral for travel, residence or transfusion in the United Kingdom, Ireland, and France from 1980 to present, which was previously considered a geographic risk of possible exposure to vCJD. Individuals who have been previously deferred for travel, residence or transfusion in the United Kingdom, Ireland and France can initiate donor reinstatement by contacting the Red Cross Donor and Client Support Center at 1-866-236-3276. Individuals with questions about their donation eligibility can contact the Red Cross Donor and Client Support Center at 1-866-236-3276.
CJD appears to be an infectious disease. It has been transmitted from infected humans to patients through the transplantation of the covering of the brain (dura mater), use of contaminated brain electrodes, and injection of growth hormones derived from human pituitary glands. Rarely, CJD is associated with a hereditary predisposition; that is, it occurs in biologic or “blood” relatives (persons in the same genetic family).
There is evidence that CJD can be transmitted from donors to patients through blood transfusions. There is no test for CJD that could be used to screen blood donors. This means that blood programs must take special precautions to keep CJD out of the blood supply by not taking blood donations from those who might have acquired this infection."
I make fun of Scott a lot, but I want to give them credit where credit is due: he writes valuable blog posts, which can be read and shared to others.
'Dylan Matthews wrote about an issue where his scrotum briefly inflated like a balloon.'
Well, his is probably otherwise empty, so maybe that had something to do with it.
Sorry, that was a cheap shot, but I had to. It's like when someone leaves donut holes out on the counter at work: you can't help but take one.
lol. I am not really a fan of liberal Vox writers either.
The "intuitive" objection to EA (particularly EA as exemplified in this piece) has teeth.
Donate a kidney to a stranger, and now you haven't one to spare in the event that someone close to you (relative, spouse, child, friend) happens to need one at some future point.
The "off-the-shelf human" intuits that a stranger-donor puts a finite multiplier on the "value" of prolonging the life of a relative/spouse/friend (the probability that this opportunity ever comes about is not pertinent, so long as it is not zero) vs. that of a total stranger. This is not how a "blood is thicker than water" standard-issue human is wired; it "fails checksum", and not everyone who breaks out in hives when reading about it is able to articulate the precise reason why. But it is a healthy reaction nonetheless.
It is part of why EA comes off as a creepy, evil cult to many people, and articles like this do their necessary bit to make it so.
Stalin famously refused to ransom his eldest son, who perished in German captivity. (the offer was to trade field marshal Friedrich Paulus, captured earlier at Stalingrad.) "We do not trade privates for field marshals." Whatever one may think of Stalin -- whether one sees his act as a heroic one, or simply further proof of his depravity -- it was an unusual act, and I find it difficult to imagine that most people would wish to inhabit a society where it would be regarded as ordinary and expected. Perhaps EAs would -- but this is why EAs are creepy, evil cultists from the POV of someone who doesn't also practice that religion.
From my non-EA, "normie" POV, to be willing to sacrifice your spouse, child, sibling, parent in order to save ANY number of total strangers, is a depraved thing. And the people who break out in hives when thinking about it, do so for perfectly healthy, valid reasons. And I break out in hives with them, when contemplating a society where people do in fact regard their family and friends as fungible vis-a-vis strangers, regardless of how numerous or imperiled the latter may be.
"For God so loved the World, that he gave his only begotten Son"... Regardless of whether you personally are a Christian, I feel that quote (and how it resonates with billions) suggests that many people consider it the noblest of sacrifices.
> "Donate a kidney to a stranger, and now you haven't one to spare in the event that someone close to you (relative, spouse, child, friend) happens to need one at some future point."
As I mentioned in the post, the kidney bank understands this objection, and in exchange for your nondirected donation, they give you a free credit you can spend on a kidney for a friend or relative in the future.
(although I'm suspicious that the kind of people who make too big a deal of this objection aren't the type who would donate to a family member anyway)
You sure are judgmental as hell. And convinced that your spontaneous reactions for and against various things are the standard by the which other people's choices should be judged. Where'd you get the idea you're the gold standard?
Not to mention they didn't read the full post where Scott addresses that specific point (as he did in the reply to this).
Seems as if his response in https://open.substack.com/pub/astralcodexten/p/my-left-kidney?r=c8sru&utm_campaign=comment-list-share-cta&utm_medium=web&comments=true&commentId=42641077 does not shoot down the objection. That is, you cannot necessarily use the "coupon" for people whom you do not yet know at the time of the donation.
I understand why Stalin did that (quite apart from him being a tyrant): it's the same logic as "you don't negotiate with kidnappers". Trading a low-value prisoner for a high-value one during war time harms your war effort. It looks like favoritism - it is favoritism - and engenders resentment amongst the ordinary people whose POW sons aren't the children of high party officials and can't be ransomed the same way. The knock-on effects on morale aren't good.
It's trying to balance out the demands of being a private individual and parent versus those of being a public figure and national leader during war time. If you're President Smith and you take that bargain, people will understand. But they won't trust you in any other decisions, and now your enemy knows you have a weak, soft spot and how to attack it. Next they'll offer to trade Private Ryan for that spy you captured, and how can you refuse? If you accept, you're hurting your own country. If you refuse, there's a ready-made scandal about how you did it for your kid but not for the Widow Ryan's kid.
That's probably why you have the Sole Survivor Act:
https://en.wikipedia.org/wiki/Sole_Survivor_Policy
God f*cking damn it, I also got rejected for mild OCD by UC Health here in Colorado. They did NOT respect my right to bodily self-determination, and this was after I had done the 24 hr of pee, full day of tests, lots of follow up tests (a weirdly high fasting blood glucose level but fine results in the challenge test, concern over LVH but turns out I'm just a runner, neutropenia but turns out it's congenital and not a problem). I didn't disclose that I had OCD, because I didn't know at the time. Initially, I didn't agree with the diagnosis (scrupulosity - which seems a little too convenient of a diagnosis for someone trying to give away their spare kidney), but as time passed, I realized he had a point. It doesn't matter though. I am confident that my OCD was unlikely to cause much of a problem with donation / recovery. I would have happily given my informed consent, and I resent the hell out of UC Health for not giving me that option. They kept on repeating that because I was in good health, they needed to be diligent about making sure I could stay in good health after the donation. This paternalistic pablum makes my blood boil, though I know physicians take "do no harm" seriously. But I would appreciate if they would widen their view. Being denied the agency to donate my spare kidney did activate my OCD rumination - did they care about *that*? What about the loss of utils - to the recipient, but also potentially others if mine were a bridging donation? Their consequentialism is irritatingly narrow. Sincere, but narrow.
Congrats for not letting the haters get you down, and completing your donation. In your face, UCSF!
Maybe I should give it another try, elsewhere...
I'm really sorry. Medical paternalists are the worst :(
I mean, it makes sense to me that someone giving away a kidney to a stranger would be dealing with scrupulosity, and that this is a good reason to not allow the donation.
To me that sounds an awful lot like "we think you care about strangers too much, so we're going to murder a random stranger (prevent you from going out of your way to save them, same difference) just to teach you a lesson."
When actual real-life doctors are taking an ethical stance that comic-book supervillains would flinch away from in horror, something needs to change.
With scrupulosity, the motive isn't caring about strangers too much - in fact, it's not based on caring for others at all. It's based on feeling completely worthless and evil, and needing to do something drastic. This is not a healthy motivation and someone who feels this way shouldn't be allowed to donate, even if it saves a life.
And it's not murder - the recipient is dying of kidney disease. It's not the same at all as murder to make a determination that the potential donor is not of sufficiently sound mind to make the life-changing decision to donate an organ.
I suspect the prospective kidney recipients would not be comforted by this logic.
If your life were at stake, you might take an organ from someone who wasn't in a good mental state to donate. Or you might not feel comfortable doing that.
Regardless, the recipient isn't exactly a neutral party to properly make that decision.
If the donor and the recipient together can't be trusted to make such a decision, who can, and on what grounds?
In many parts of the US it's circumstantially permissible to shoot a complete stranger with a pistol, or otherwise gravely endanger their life, in order to preserve your own. Their mental state is seldom considered relevant - debate is more often focused on availability of alternatives, "duty to retreat" and so on.
Granted, there's less time pressure involved in kidney transplantation than in violent self-defense, so it makes sense to demand more careful scrutiny... but donating a kidney in a proper hospital is considerably less dangerous than a gunshot wound, greater harm is being prevented, and the closest thing to a viable alternative anyone's found so far is dialysis, which seems to be on a comparable level of nobody-should-be-forced-to-do-that as "retreat from your own home." Why is informed consent from the donor insufficient for what seems like a much clearer win?
Do you have scrupulosity? I see that you've commented about multiple times so you must be familiar with it.
To the psych, scrupulosity was the best-fit OCD diagnosis for me. I am unusually concerned about doing right by others, and sometimes I do feel like a bad person for no particular reason. The latter is pathological, but it doesn't mean that it is the source of all my altruistic impulses. I have a bit heart and a lot of natural empathy. I've cultivated enough mindfulness to see which actions bring me sustained joy - and acts of kindness is a big one. Like many EA/LWers, I try to live the philosophies with which I agree - and I have arrived at these philosophies with care. So while I see that the psych had some accurate observations (and frankly provided me some life-changing self-insight), he reduced all my geeky/aspie/philosophical/empathetic altruistic intent into pathology.
It was incredibly frustrating and even a bit hurtful. There were other problems as well (such as my social worker inappropriately suggesting that I have body dysmorphia, because I was asking questions about how soon I could resume my cardio after the donation).
A much better model would be for the psych to advise - to let me know his thoughts and the risks. Why is my "informed consent" insufficient in this case???
Psychologist here, and OCD specialist. I thought it might be helpful to lay out some info about OCD in general and scrupulosity in particular.
There are a lot of behaviors and patterns of thought that *could* be considered scrupulosity: religious observances; adherence to various regimens of exercise, recycling, charitable donations, whatever; ruminating about ethical issues. The diagnostic bell-ringer is that OCD behaviors are driven by a deep, fear of bad consequences if one does not do them. And the OCD sufferer recognizes that the fears are irrational. Here’s an example: I have a patient who is in fact genuinely religious. When he hears on the news about tragedies he says prayers asking god to help the people involved, and those are real, heartfelt prayers. He also feels compelled to stand before each crucifix in his house and cross himself before he leaves his home or goes to bed, and that is an OCD ritual. He does not experience those rituals as expressions he religious devotion, and in fact says "doing that isn't real religion." He does those rituals because he fears something bad will happen if he does not do them. Mostly he fears the death of family members. On the same occasions he also does a ritual checking of his stove to make sure it's really really really off, and checking the stove feels to him exactly the same as crossing himself -- a precaution against something bad happening. If he skips either of these rituals he feels gnawing anxiety.
Here’s an even more extreme example of the difference between religious scrupulosity and the observances made by genuinely religious people. I had a patient who was an atheist, but avoided saying “lived” because it was “devil” spelled backwards. His fear was that if he said “lived” he would be demonically possessed. He did not believe in demons, either, or in anything else supernatural, but was still subject to powerful, unabating anxiety about demonic possession if he said “lived” or skipped any of his many other rituals (touching and tapping things, repeating actions).
Another diagnostic criterion for OCD is that the rituals, together with fretting about rituals and worrying about the feared bad consequence take up a substantial part of the person’s time and mental energy. People with scrupulosity are preoccupied with their rituals and the bad consequences they fear if their rituals are inadequate. It is at least in the back of their mind all the time, and often in the forefront. They are preoccupied the way somebody on the verge of backruptcy is about bills, creditors, the desperate hunt for a solution, dread of the bankruptcy itself.
So for those wondering whether their ruminations about morality or their commitment to actions they see as ethical are in fact scrupulosity OCD, the 2 criteria above should be helpful: Are you doing these things mainly because you dread some bad consequence, especially one that’s extreme and implausible, if you don’t do them? That weighs in the direction of OCD. And does fretting about the ethics of your actions take up a *lot* of space in your mind? That also suggests OCD. And here’s a third thing to consider if you’re wondering if your ethical concerns are mostly scrupulosity OCD. Have you ever had any other form of OCD? Have you felt compelled to tap things, repeat actions, arrange things a certain way, keep things way cleaner than necessary, neutralize “bad” thoughts with good ones, avoid certain “bad” numbers? If so, that makes it likelier that your preoccupation with ethical issues is OCD. But of course it might not be. Ask yourself whether thinking about ethical matters *feels* like the OCD you’ve experienced.
Thanks for these details. Would it concern you at all if someone with an OCD history donated a kidney to a stranger out of a feeling of guilt or moral obligation? How do you see Scott's situation?
Many Thanks for the informative examples and criteria!
Sounds like your religious patient has a good handle on his scrupulosity, and I hope he sees an improvement there. Thanks for the detailed reply and good luck in your professional endeavours, you seem to be doing good work!
I'm sorry you were labeled and pathologized. That's not right. I really hate comments to the effect of "that's just being aspie" or "I know better than you because you're aspie" - sounds very frustrating.
You had another comment about workplace OCD but it seems gone now - did you delete it?
I'd be concerned about acts of kindness that significantly hurt you, like donating an organ, which I see as an act of self-harm, or needing to make apologies that hurt your position at work.
When you say "after the donation" do you mean you donated a kidney also?
I'd say "informed consent" is not sufficient in a situation where you're trying to treat a problem improperly. If I have the flu and ask a doc to remove a kidney because I think it will help with the flu, even if I give informed consent, should the doctor do it?
Suppose Alice is sinking in a flooded river, while Bob stands on the shore, swinging a rope overhead. Before the rescue can be completed, Eve snatches the rope away from Bob, berates him for publicly indulging his cowboy-cosplay fetish, and insists that he take a six-week lifeguard training course before proceeding. He agrees with the diagnosis and does so. Meanwhile, Alice drowns.
"So you're saying I would have just made the situation worse?" asks Bob.
"No," says Eve, "that lasso trick almost certainly would have worked. I just thought you were doing it for the wrong reasons."
Has Eve de facto murdered Alice?
if Eve did that with the intent to kill Alice, then you could argue that, yes. If that wasn't Eve's intent, I don't think you could call that murder.
But more importantly, that situation is not comparable for two reasons.
1. In your scenario, Bob is a rugged individualist perfectly capable of rescuing Alice on his own. But with organ donation, Bob is not singlehandedly removing his own kidney and implanting it in Alice. Rather, Bob is asking medical professionals to use scarce time and resources for this, and further asking for other scarce resources, eg from nonprofits. Bob can't save Alice without the help of the whole network of professionals and the organ donor system. Further, Bob is asking for a special status, the status of being an organ donor, though that's a lesser concern.
None of these things are free, and medical professionals have a duty to make sure their patients are qualified and have informed consent before they start removing organs and start allocating scarce resources.
2. The organ donation example is more like a case where Bob, in fact, can't swim. Or at least a case where there is a good chance that Bob can't swim and will fail to do the rescue or will injure or kill himself.
What I mean by that is that organ donation harms the donor, as Scott points out (but minimizes) in the essay. It has costs on the system in that Bob now has claims on other organs. There's also concerns about regret and psychological harm to Bob, and not treating Bob's actual problem.
So a better analogy is that Alice is drowning, and Eve is a lifeguard trying to rescue hundreds of people. Bob has a lamprey attached to his arm gradually eating him, and erroneously believes that if he rescues Alice, the lamprey will stop, so asks Eve to stop rescuing others and take him to rescue Alice. Eve says "no, I'm busy rescuing others, and let's try to actually treat that lamprey."
This is so interesting — I was a non-directed donor through UC Health in CO less than two years after dealing with some moderate OCD and undergoing about six months of therapy for it. When I had the evaluation at UC Health, I told them about this up front, including the fact that I felt like the therapy worked and I had improved a lot. Eventually, as part of the evaluation, they basically had me sit at their computer and do this long questionnaire that was seemingly a diagnostic assessment for a bunch of different mental health disorders at once.
I remember noticing that there were OCD-related questions in there, but none of them really related to my experience, so I usually ranked them pretty low on the agree-disagree scale. Like, they would mention specific concerns I didn't have (like contamination) or specific compulsions that I didn't do (most of mine were mental, more ruminating than physically double checking things). Also, I felt much better by this time, so even if that questions had related to my experience, I'm not sure if I would have rated them much higher.
After I finished, the psychiatrist at UC Health graded the questionnaire and was like "oh yeah you actually scored lower than average for OCD, you're all good" — which felt strange to me given my medical history (even if they want to defer to diagnostic assessments, I had scored fairly high on the Y-BOCS, a gold standard diagnostic assessment for OCD, when I was in therapy). I had heard so much about how strict the evaluation was, so it just seemed weirdly permissive. I was expecting to at least have to get a letter from my old therapist or something like that. But of course I felt ready to donate so I wasn't gonna put up a fight for them to deny me! Anyway, the rest of the evaluations all checked out and I had the operation a few months later.
I thought of this when I first read Scott's story, but hearing your experience at the very same hospital made me want to share this. I think it updates me toward the process being very arbitrary and variable depending on the specific people conducting the evaluation. Trying at another hospital makes sense to me, if it's still something you want to pursue.
I considered kidney donation at one point, but my spouse talked me out of it. Their logic was that while kidney donors don't have worse outcomes than the general population, they DO have worse outcomes than those who pass the standards to become donors.
The fact that the medical community elides this distinction was enough to convince me that they're lying, and shouldn't be trusted with my life (or kidney). I'm happy to reconsider if that situation has changed.
The medical community's eager willingness to "tell the noble lie" at every possible perceived opportunity, for even the flimsiest notional "common good" (as revealed in the most public and painful way possible during the COVID years) has killed and will continue to kill countless people.
Yes, but so does illness, and the medical community, despite its many fucking awful flaws, is better at treating illness than the other possible candidates: practitioners of new age bullshit, barbers, religious leaders, sellers of snake oil, and your Aunt Marge.
The question of why people — not all of whom can be accurately described as "idiots who only trust Aunt Marge" — more and more often prefer to visit witch doctors, refuse a vaccine, etc. is IMHO interesting.
The conventional view of “doctoring” seems to be that there are precisely two fundamental types to choose from — “witch” and “legit”. But this IMHO does not fully cover it. It elides an important distinction. There are actually *three* — 1) “witch” ; 2) “legit MD, working for the State or a de-facto appendage thereof.”; lastly, 3) “legit, state-of-the-art MD, working 100% strictly for You, the (paying) patient.”
“1” needs no elaboration. “2” describes every doctor I have ever visited, and likely all of the doctors that you and everyone you know — unless you personally know an oligarch or high official— have ever visited or will ever visit. Chances are that you’ll never encounter a “3” at all, and may even disbelieve entirely in the existence of the distinction between “2” and “3”.
If you or any of the other patients at a practice have ever paid there with “health insurance”, the doctor is a “2”. He is working for the State (and/or its tentacle, the HMO) and his job closer to that of a prison doctor than to that of e.g. Kennedy’s or Kissinger’s personal doctor. That is: to discourage you from visiting him “unnecessarily”; to make it so that when you fall seriously ill, you “die cheaply” (“cheaply” for the organization that employs him, that is; you, OTOH, are likely to lose your savings, house, etc.) ; and in so far as treatment is concerned, “public health” and ROI trump any of your “unreasonable” and potentially expensive personal desires, e.g. to feel energetic, to live past the retirement age in your jurisdiction, etc.
If you’ve read this far — my hypothesis is that witch doctors sucker in increasingly less-stereotypically “illiterate” people — by convincingly simulating the “3” experience. The actual treatment outcome is actually less important (and for a serious condition, often the only difference in practice is the cost. Where the “witch” reliably beats the pants off the MD.)
The “witches” have an increasingly-easier time giving a satisfying, to many, “3”-like experience, especially given as type “2” doctors more and more overtly behave like veterinarians at a feedlot cattle farm. (Or like Mengele, if you’re unlucky. With the difference that Mengele merely painfully murdered his patients, for what he perceived as “the common good”, but at least did not while doing so bankrupt their estates…)
TLDR: many folks would actually rather feel less like feedlot cattle, and possibly leave an intact estate to their heirs, than to live an extra year or two. And they are not necessarily idiots.
I didn’t say the people choosing against seeing doctors were idiots, I said they were getting worse medical care. Skipping medical care altogether will on average reduce life span way more than one or two years. I am quite angry at doctors myself, and in fact am currently seriously considering getting a type 3 doctor, a concierge doctor, despite the fact that will do me real financial harm. So I’m totally with you on anger. I simply would rather receive the type 2 medical care
I loathe than go without monitoring of one fairly scary health problem I have, and routine exams to catch other serious health problems. YMMV
I've personally known two people who recovered from their (to be fair -- mostly iatrogenic, as it happened) conditions after switching to "Type 1" practitioners in desperation. Admittedly this is "anecdote" (incidentally, being insistently told to unconditionally disregard their lived experience in favour of Official stats is one of the reasons why some people end up "setting the bozo bit" on "Type 2" doctors...)
FWIW I'm in USA and sincerely hope to get out -- or at least to die a quick and violent death -- before reaching the age where one is certain to take an interest in doctors. I doubt that I will ever be able to afford the services of a genuine "Type 3". If you can afford one -- you have done very well in life.
OK, you know 2 people who recovered after seeing witch doctors. I know someone who was struck by lightening twice. I am not about to conclude from that that getting struck by lightening is common. You cannot go by the experience of 2 of your friends. The circle of people each of us know is small, and not representative of the population as a whole. You need to look at studies of the differing life spans of people who do and do not receive conventional medical care. If you’re gonna bag seeing doctors you better get good at reading research and understanding statistics so you can do good assessments of various symptoms and health risks. That’s what I do so as to minimize doctor visits.
And by the way, seeing a concierge doc adds $6000 per year to your health costs. You don’t have to be doing all that well to afford it. Actually the fact that I’m going to find that amount painful to part with is pretty good evidence my income’s not that awesome, LOL
Can you elaborate? I have a horrible iatrogenic condition and I'd do anything to recover.
Interesting. I agree insurance docs are biased by the insurance, though I don't see how that's the "State" - it's typically either a nonprofit or for-profit health company.
But why do you say you'll never see a 3? If you pay cash for docs, which I always do and many people do, doesn't that make your docs 3s?
Also, paying cash in most cases is actually a lot cheaper than going through insurance since you don't have to pay exorbitant monthly premiums and deductables, you often get discounts, and you don't have to spend many hours dealing with insurance.
> I don't see how that's the "State"
Health "insurance" in USA as we know it (which has very little in common with e.g. fire insurance, philosophically or legally) is a creation of the State. And not merely because it is micromanaged by the latter, but also for the reason that the astronomical pharma and procedure prices which create a demand for such "insurance" are atrocities perpetrated, quite deliberately, by the State -- via the patent and licensing cartel regimes, respectively.
> If you pay cash for docs, which I always do and many people do, doesn't that make your docs 3s?
Nope, not any more than paying cash at e.g. "Food Depot" (a grocery in Baltimore where almost all of the customers pay with "food stamps") gets you something other than the very same tinned fish and soups everybody else there is buying.
> paying cash in most cases is actually a lot cheaper than going through insurance
Plausible, until you get a long-term prescription for just about anything. Or any kind of procedure (even routine dental work.)
In a lot of situations you have to do your own research. In fact I'd say you have to do it in most situations where you're dealing with am entity you don't know well, and your interests aren't perfectly aligned with theirs: buying a car or a house, choosing a school or a place to work, donating a kidney, donating to a cause. If the other party wants you to make a certain choice, the info they give you is almost certainly slanted in the direction of the choice they're hoping you'll make. That can happen even if the other party is not conscious of shading the truth or flat-out lyiing..
I agree that the doctors aren't giving full and accurate information to potential kidney donors. It's true that kidney donors are less likely to have kidney disease than non-donors -- but it's also true that they're more likely to develop kidney disease if they donate a kidney than if they don't. So, yeah, you were given an elided version of the truth, but as unfruths go this one does not seem to me so awful. First of all, it's not a flat-out lie. Second, the full truth may be close to the half-truth you were told. Even if people who donate a kidney have more kidney disease later in life than they would if they had not donated, maybe they only do a tiny bit worse -- like 5% worse. Third, it would not surprise me at all if many of the doctors telling that elided truth do not realize it's an elided truth. I seems to me that medical training does not teach doctors much about statistics and research design. I get a publication with info about current medical research, and people are able to leave comments. I've been astonished by the ignorance of stats and research design evidenced by doctors' comments.
It's also worth noting that when Scott told the doctors the radiation from the CAT scans posed a greater risk than kidney donation itself, the doctors were surprised, but did not argue and try to convince Scott he was wrong. So they do not sound hell-bent on proving to him they knew everything and were confident the procedure and accompanying tests had zero risk.
In short, the mild dishonesty of medical professionals regarding kidney transplant risks is not that big a deal if you are realistic about what human transactions are like. Do your own research, as Scott did, and then decide whether you're willing to take on whatever risk there is.
I mean, thanks for validating the approach I already took?
I think part of what irks me so much is that when I've asked doctors why they object to allowing kidneys to be sold (e.g like blood, sperm, or eggs), they've stated that money would destroy the trust between doctor and donor. Yet, for some reason, doctors don't think that THEM getting paid creates any conflict of interest (note that every person in that operating room except for Scott received something of tangible value).
So discovering that (unsurprisingly, to me, and apparently to you) they are indeed tainted by the conflict of interest made their lies particularly galling.
>So discovering that (unsurprisingly, to me, and apparently to you) they are indeed tainted by the conflict of interest
It is not in the least surprising to me that they are tainted by conflict of interest. The first point I made was that you have to assume that any person or organization you do not know well is. We all are to some extent.
Here is an example from my life. I try hard in my professional life to be fair-minded and honest, and not to be greedy and excessively self-protective, but I recently realized that there was an issue I was making no effort at all to be fair-minded about. Psychologists are licensed only in the state where they received their license. To be licensed to practice in another state they have to jump through the other state's hoops, which are likely to be similar but not identical to the ones in their own states. They also have to pay a few hundred dollars for the license. But there is now an agreement called PSYPACT that most states have signed on to that allows psychologists in a PSYPACT state to practice in any other PSYPACT state with much less bureaucratic hassle and expense. I would like to be able to practice in other states, mainly because many of my patients are graduate students, and when they get their degree they usually leave the state. There have been several who wanted to continue working with me via teletherapy but could not because I was not licensed to practice in the state they moved to after graduation. Besides wanting to give these people the continuity they want, there is also some self-interest on my part involved. It's not financial -- I would not have trouble finding new patients to fill the spots vacated by those moving away -- but it's self-interest nevertheless. I *like* these people, and enjoy meeting with them. Also, our work together is going well, and when you take a new patient there is maybe a 30% chance things will work out as well as they are with these people who want to continue seeing me.
So my state legislature is one of the few that has not passed PSYPACT. And I have been walking around for months wondering irritably why the hell the don't just vote for this obviously good piece of legislation. Recently it occurred to me that it's possible that PSYPACT is harmful to some, and that the reason PSYPACT has not been passed is that the group who will be harmed is arguing against it. I don't have any particular group in mind, but it does seem possible that joining PSYPACT gives some professionals an unfair advantage, and harms other. It took me a year to even have that thought. That's an example of reflexive, unintended, self-interest on my part.
> thanks for validating the approach I already took?
I don't think I did validate it. My advice was to assume the medical professionals would not tell you the full, unvarnished truth, and to research the risks yourself. If they were acceptable, go ahead and donate. It seemed to me that what you "researched" was whether doctors tell half-truths and lies about performing a procedure they get paid for. Then, angry because you saw evidence that doctors do indeed do that, you decided not to donate a kidney. It seems to me that the confirmation you got that doctors are indeed somewhat dishonest in a situation where they stand to benefit is highly relevant to how angry you should be at doctors, but irrelevant to the question of whether you should donate a kidney.
Scott has now researched the daylights out of kidney donation safety for you. If you have remaining questions about safety, research them. Then, if overall safety is acceptable, donate. After you are fully recovered, write the doctors a blistering letter about half-truths and conflict of interest. Put up a post here. Publish something, if you can. By the way, I am at least as angry at doctors as you are, because of various events in my own life.
Why would your doc want you to donate your kidney? Presumably they are invested in your health and also don't want to get sued.
Most of the stuff I read made this distinction clear and seemed pretty honest about it.
That's good to know. When I was looking into it around 7-8 years ago, it wasn't commonly mentioned. I was also not impressed with the quality of the studies that I reviewed, but it's possible that statistical literacy within the medical profession has improved.
Setting aside the long timeline for scientific development and regulatory approval, why is the ultimate solution not "let's grow infinite kidneys from pluripotent stem cells"?
https://www.science.org/content/article/early-stage-human-kidneys-grown-pigs-first-time
Likely the same reason why we hear from the EAs "tithe 10% of your salary for mosquito nets" and not "re-legalize DDT". Hence the "re-branded Christianity, on steroids" flavour. Self-flagellators want to feel righteous through painful sacrifice -- rather than by firing a disintegrator ray at the very root of a problem with minimal casualties.
Not to mention that re-legalizing DDT would buy 0 castles.
Throwing around more DDT wouldn't solve the malaria problem at this point - insects had already started measurably developing resistance to it back in the 1950s. That's actually a big part why there was such a push for widespread use, to "finish the job" before it failed completely. Better alternatives eventually emerged: https://worksinprogress.co/issue/why-we-didnt-get-a-malaria-vaccine-sooner
I think this is the ultimate solution obviously. There are groups pursuing multiple approaches.
There is the lab-grown from ipscs to organoids to kidneys pipeline. Here they have trouble vascularising any tissue that grows, so the organoids start necrosing after they grow to a size where oxygen can no longer reach to them via diffusion. There are groups working to solve the vascularisation puzzle, which would be useful for everything, not just kidneys. But its hard. Also from these clumps of renal tissue, its hard to get higher order hierarchy. So in these organoids you have nephrons (which are the functional units of the kidney), but they are all connected to each other like spagheti, whereas in the actual kidney during development they connect through a branching structure, so that the urine can drain out from them. At the moment getting the right signalling is hard.
There are groups working on using pig kidneys. Pig kidneys on their own are not compatible with humans, there will be a very strong acute immune response that will cause necrosis of the kidney and rejection. So these groups change certain genes to reduce the immunogenicity of the pig kidneys. This is hard, there are some prime immune targets, which you can do things about. But there are a lot of antigens the immune system can target. Just from memory I think the most one could stay implanted in a non-human primate under strong immune suppression was a few hundred days.
There is our group at UMC Utrecht, and UCSF group working on a bio-artificial kidney. These rely on some kind of artificial membrane to act as a blood filter which is the job of the glomerulus in the actual kidney, and proximal tubule cells for the resorption of all the stuff we need that makes its way through the filter. Here 3 main challenges are; blood compatibility (the artificial membranes must be blood compatible so proteins must not adhere and block pores and thrombus must not form), strength (membranes must be very strong or designed in such a way as to have low stresses, even a micron scale fracture will take out the whole device), cells must keep alive in the bio-reactor. These are all very substantial challenges that I hope we can overcome.
There are also the chiral approaches which I think you linked to. The end result is a combination of some pig and some human cells which might be less of an issue immunity than the full pig kidneys I mentioned before but still has challenges.
There are a lot of horses in the race, I really hope we find a solution that can get people off dialysis.
Thank you for this thorough response! Fwiw, I recently spoke with the founder of a company called Frontier Bio, which has seen early success with larger-scale vascularization on multiple tissues, working with Mayo and a government agency... Here's a summary of what I learned. I'm sure there are many other groups doing promising work.
Frontier Bio - bio-printing tissues, namely lung tissue, brain tissue and blood vessels on a larger scale than previous startups. They have achieved near 100% vascularization of brain and lung tissue grown from stem cells using a proprietary application of growth factors. Unlike Prellis and Volumetric, they are printing actual cells which self-assemble into larger structures, and growing those cells together in vasculature to sustain them, rather than just printing vessels and seeding cells in a hydrogel. They have one patent from their blood vessel work with the Mayo Clinic and will file for two others for neuro and lung tissue this year. Because they are printing cells, their technology can be applied to drug development as well as testing viral responses. Their near-term prospective buyers are directors of research at pharmaceutical companies; ultimately they hope to print entire organs that could be transplanted.
URL: https://www.frontierbio.com/
The ultimate solution is to become immortal beings of pure energy. The medium term solution is to grow infinite kidneys from pluripotent stem cells. The short term solution is to donate.
Pure energy seems too unstable for an optimal immortality substrate, but I suppose we can cross that bridge when we come to it.
Scott - I admire and support your generous action, and I agree with you on the near-term solution. Readers interested in new biotechnology approaches may want to read about early success in xenotransplants from pigs: https://archive.is/wbm0F
"But I think about myself at age 20, a young philosophy major studying utilitarianism. If someone had asked me a hypothetical about whether I would donate a kidney to a stranger in need, I probably would have said yes."
I think about my alcohol consumption at age 20 and if someone had asked me a hypothetical whether I would donate a kidney to a stranger in need, I probably would have said no effing way.
Isn't it your liver you need for alcohol consumption?
I donated in 2021 and have nothing but good things to say about the experience so far. They did take my right, the jury is out on whether this has lead me to become evil.
I suffered from depression as a teenager and was briefly hospitalized at one point. However, the psychiatrist who did my eval was very reasonable about the fact that I am a mentally healthy adult, and it wasn't an obstacle at all. This was through Tufts in Boston, who I would give high marks in every category, including catheter insertion.
Conversation with a nephrologist:
Me:
In your experience, is there a relationship between kidney disease and being a kidney donor?
Nephrologist:
Pre-donation there is a strong relationship between healthier than average & having great kidney function.
Post donation there is an increased risk of mild kidney disease; people who donate a kidney go on to have kidney failure at a lower risk than that of the general population (but they started out better).
People tend to be very satisfied that they have donated a kidney to a loved one (dialysis stinks).
All of that was for the US …. In countries where people sell kidneys outcomes for the donors are NOT so good.
Me:
Thanks. So in your experience, kidney donors are underrepresented among people with severe kidney disease?
Nephrologist:
Yes (in the US).
>kidney donors are underrepresented among people with severe kidney disease<
I definitely read that as "people with severe kidney disease should be donating more kidneys."
"The Talmud is very clear: that voice is called the evil inclination, and it dwells in the left kidney. There is only one way to shut it off forever. I was ready."
So why you passing off this evil onto some other poor slob? Couldn't you have handed over your right kidney?
Some "Effective Altruist".
That's how you become an effective altruist though, before left kidney donation, thinking about charities gets driven out by intrusive thoughts about crypto, whale puns and factorio train systems. It is only by purging this primeval source of malice that allows a person to write a check to AMF.
Please educate yourself on the natural lifecycle and migratory patterns of EAs before opining in the future.
No, see, if you install a left kidney upside-down, it becomes a right kidney. It's pure gain.
I really love this explanation.
I discuss my reasons for dismissing this consideration at https://www.astralcodexten.com/p/another-bay-area-house-party (CTRL+F "kidney")
So are you donating the kidney?
"The usual rule of thumb is that one extra Sievert = 5% higher risk of dying from cancer, so a 30 mS dose increases death risk about one part in 660."
Aren't you confusing absolute and relative risks here? "5% higher risk" means 5% higher than the *already low absolute risk of getting cancer in the first place*, doesn't it? And that is certainly many orders of magnitude lower than 1 in 660.
EDIT: The correct figure, assuming 5% means relative risk and using the cancer incidence numbers from Google, is 1/4650. There's also the issue that Scott is comparing that number directly to the 1/10,000 risk from surgery despite the fact that death from surgery would be immediate and death from radiation would be many years in the future. Once you take that into account, surgery poses a far greater danger.
> "5% higher risk" means 5% higher than the *already low absolute risk of getting cancer in the first place*, doesn't it?
How Scott put it is bad, but what it means statistically is 5% chance of lifetime radiation-induced cancer. I looked it up.
Could you source that? I read through Scott's linked source and their phrasing made it sound like relative risk. Also this source explicitly says it's relative risk: https://www.imagewisely.org/Imaging-Modalities/Computed-Tomography/How-to-Understand-and-Communicate-Radiation-Risk
"The current accepted values of relative risk are given in Table 2"
Table 2 says it's 5%.
Also the math just doesn't make sense. Google says there are 80 million CT scans per year in the US. If 1/660 of those wound up with cancer then CT scans alone would account for ~10% of all cancer in the country. That's like 1/4 of the total from smoking. There's just no way.
Yeah, the phrasing is bad.
The odds are lifetime. Your link also puts "lifetime risk of radiation-induced carcinogenesis" on a neat little chart (Figure 2), which is similarly ~5% for an adult. I think "5% relative risk" in this context means "added 5% lifetime relative to a person who is not irradiated," not "5% more than previous risk (e.g. 15% so 15.75%)."
> There's just no way.
I mean, it is possible that these statistics are wrong, however, these ARE the statistics that are used. If true I suspect CT scans will not go down in history well.
>I think "5% relative risk" in this context means "added 5% lifetime relative to a person who is not irradiated," not "5% more than previous risk (e.g. 15% so 15.75%)."
I'm fairly sure that's wrong. My linked source clearly delineates absolute from relative risk and explicitly labels the 5% figure as relative:
"Absolute risk is defined as the probability that a person who is disease free at a specific age will develop the disease at a later time following exposure to a risk factor, e.g. the probability of cancer induction following exposure to radiation ... The relative risk model assumes radiation increases the natural incidence of a cancer and it is expressed as a fraction or multiple of the naturally occurring risk"
The absolute lifetime risk of dying from cancer is 1/7, according to Google. So the absolute risk from 1 Sievert is 1/7 * 1/20 = 140 and the absolute risk from 1/33rd of that (30 mS) is 1/140*33 = 1/4620.
There's also the issue that Scott is comparing the radiation risk directly to the surgical risk without taking into account that death from cancer would happen many years into the future while death from surgery would be immediate. He would have to convert both into QALYs lost in which case the risk from surgery would be clearly higher.
This really brings back some memories. I used to live in the Bay Area, and found it a very lonely place for me, working, unable to figure out how to gain friends or love. I was a mess, really.
Then I gave blood and ticked a box about bone-marrow donation, and I was a match. I walked around high, it felt literally the kind of high I'd pay for drugs to get. Whatever dam of brain chemicals that I kept held off until I felt like a worthwhile person, somehow I turned the inaccessible spigot, and I felt authentically good for maybe the first time ever. This is what it must be like to be pregnant, I'm crossing the street for two people!
I was well taken care off, the operation went well, but I got some kind of a bleed in my leg and i was in pain for some months after, but with every twinge I felt the hero. And, well, the leukemia patient died, so I'd also advise anyone donating it's a harder row to hoe to get that outcome information. My leg still (30 years on) has minor problems, but with that meaning attached, I don't count it as a loss; maybe I've even needed that reminder. It's not like I've done much better at the self-care since then really.
I think you did something noble for an individual's life at no small cost to yourself. I don't think its fair to make it about effective altruism in the negative. The individual decision and act was good, and whether or not a single person chooses to explain it was enhancing QALY years, or you felt a strong compassion, or because you felt a religious duty uncoerced doesn't change that. Not everything need be a debate on a universal philosophy or the flaws of such.
i am older now and worry though. It's never good to hear anyone you interact with even slightly has been in the hospital. It's a place we need but never want, if you get my drift.
I hope the recovery from the uti was quick. Hope the wife is ok too. Supporting can have its own fears and worries. Please take it easy.
So THAT’s why you weren’t at the Meetup. 😉
Yeah, sorry! The hospital kept me in the dark about when exactly the donation would be for a while, and I tried to plan the meetup for when I would definitely be recovered, and I ended up being cleared to fly home two days before and not wanting to rush, sorry.
All good. I’ll catch you at the next one!
You wrote: "This is great - my grandfather died of kidney disease, and 10 - 20 more years with him would have meant a lot."
You didn't mention this in your risk calculation for donating! Did you look into the likelihood of developing kidney disease conditional on a family history? Seems like a relevant calculation, I'm guessing that you looked into it and found no increased risk...?
My grandfather smoked like a chimney and ate very poorly and got kidney disease in his late 60s, which I think is almost an expected outcome. I did mention this to the evaluators.
You're a good man, Scott. And this was a good writeup.
I'm old enough that this probably wouldn't be a good choice for me now, and I can't honestly say I'd have done it ten years ago if I'd thought of it. But, in spite of having donated my entire blood supply something like ten times over, and being on the bone marrow donor list most of my adult life, it never even occurred to me that this was a possibility before now. You'd think that, being on the list of people who is clearly open to donating non-vital organs, somebody would have mentioned the possibility. And probably they did at some point, but not in any way I noticed and certainly not with any assessment of the risks.
So there's clearly an information deficit here, and one you've helped deal with. Let's hope that this post gets lots of signal-boosting. Speaking of which, if EA already has the reputation in some circles as Those Wacky Nice Guys Who Keep Giving Away Kidneys, what's the tradeoff on bednets vs. public service announcements re kidney donation?
There was a discussion at an EA meetup about this, but basically if you earn a software developer's salary and you're donating the marginal dollar (I.e. not a fixed amount) it is overdetermined that you save more lives by going to work. If you do want to donate the kidney anyway you have enough PTO, or sick leave in order for this to be "okay" on a, I think QALY adjusted basis. I don't remember what the exact crossover point is.
We mainly did this by comparing the QALY adjusted numbers Scott posted here and compared it against the median recuperation period and plugged in various weekly wages, then compared that to the 5k~ statistical life saved for an AMF donation, so most likely grabbing the Givewell spreadsheet and simple math would be able to regenerate the answer.
Long as we're considering alternatives, how about using those software-developer skills pro bono on building and refining some sort of open-source search engine or wiki for connecting cancer patients with relevant clinical trials? Per https://bessstillman.substack.com/p/please-be-dying-but-not-too-quickly at least some of the relevant data is a matter of public record, but the indexing is staggeringly terrible, and relevant megacorps aren't likely to fix it on their own since that would make strategic intel more accessible to their rivals.
I would be glad to contribute to a project like this. I know that a nephrologist-mathematician couple overhauled the kidney donation algorithm about ten years ago, and were able to drastically extend the average donation chain length.
The post you linked to mentioned that there's companies trying to enter this space, but implies the results are still pretty bad. Do you have any suggestions or resources for possible contribution?
No idea, sorry, only heard of it myself within the past few days and my knowledge of software design is strictly amateur. Asking the author of that linked article might be a reasonable place to start.
Fair enough for EA internally, but there's also the eight billion or so people who aren't Effective Altruists and aren't going to be donating every marginal dollar. Many of those people do donate blood and bone marrow and the like, and some of them might donate kidneys if they knew it was a practical and surprisingly risk-free option. And there's no altruistic cost in their recovery time meaning they earn less money to give to EA causes, because that was never in the cards in the first place.
What's the payoff on trying to get the word out to the non-EA community about the safety and efficacy of non-directed kidney donation. Is there any low-hanging fruit worth going after there?
Unfortunately, the only ideas I have in my head are really long shot stuff, like a kidney donation arc in some sort of mass media tv series or movie glorifying it with details to contact the relevant organizations. I think there was some noise about leafleting converting people to vegetarian / reducing meat consumption in the Animal Welfare wing of EA, but I haven't paid a lot of attention and every year after that I remember hearing it was much less effective than advertised.
Maybe the reverse of raising awareness among EA circles on like, bone marrow and stem cell donations would also work. Not too high impact in terms of net good compared to malaria nets, but more likely to draw from the "feel good" bucket of energy rather than the "oh no the world is full of suffering pits Aaaaaaah!!" bucket.
Sorry, I should do a lot more research for this question, but been feeling low energy.
"When you donate, you can give the organ bank the names of up to five friends or family members who you’re worried might end up in this situation. In exchange for your donation, they will make sure those people get to the top of the list if they ever need a transplant themselves."
Can you change the names later on? I'm thinking about the sorts of incentives this could create.
I think no.
Hm, that's unfortunate. That means if you really care about your (future) loved ones, you should forgo donating.
Congrats!
Rather than direct payments, a lifetime healthcare benefit, like early admission into Medicare or some other coverage, would (a) most directly address people's principle anxiety about the procedure, and (b) be more digestible to those with a strong... sanctity drive if you want to be Haidtian about it.
What I mean is, it might help counter instincts of "ick paying people to do charity is bad" or "ick paying people to do bodily sacrifice is bad." (Even though, at worst, sure it is kind of a sleight of hand. But if people genuinely prefer packaging a fungible benefit in a particular way, why argue?)
The healthcare angle might especially entice those who want to hang a shingle, but are worried about missing out on a system dominated by employer-provided care.
If every solo contractor (in tech, professional services, entertainment) had the option for lifetime free healthcare by donating a liver or kidney, you might close the shortfall.
Tangent, I had assumed opt-out deceased donor policies were widely considered to be an easy policy win here, but recent research seems skeptical, so I'm more unsure:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128443/
Specifically the clarification of how Spain's system works in practice surprised me. I'm not quite convinced opt-out is net harmful, but understand the risk of discouraging voluntary donations, so maybe the better investment is in donor counselors for grieving families and improved logistics for abruptly available organs.
(Hang on a second, would UCSF have taken your kidney if you died in a motorcycle accident in their parking lot? Was that their preferred admission path!?)
I think for ethical and PR reasons their goal is to minimize the number of people who donate out of desperation, and using "Medicare admission" as the carrot would mean that some people who get very expensive illnesses that they don't have enough private insurance to pay for would have strong incentives to donate out of desperation, at exactly the time it would be worst for their health.
Definitely, though small patches could help. For one, you noted we already have aggressive, skeptical screening (perhaps to a fault). Beyond that, a benefit that kicks in gradually or with a delay would be another straightforward patch, similar to what might be used to prevent monetary windfalls. Admission to Medicare X years early, tweak X as needed.
This is mainly proposed as a stepwise improvement for market based policies, which must weather similar critiques. At least here, you couldn't donate then use the healthcare to settle gambling debts... unless you have engaged in a very strange series of barters with the mafia.
Alas, some stepwise improvements are still not a big enough step. If someone is strongly against any incentives, this is still one of those. If people are incentive curious, then compensation through health benefits might be a gateway.
Regardless, genuine thanks for what you've done, total badass hero move.
Very cool! Wanted to go through with this earlier in life but my family was adamantly opposed to it. I've been donating blood and figured bone marrow donation would be a good compromise. I got the swab kit for the bone marrow donation and promptly forgot about it - tonight I'll open it. This post was exactly the push I needed. Cheers!
Does type 2 diabetes automatically disqualify you from donating?
Tangential to the donation issue, but are there any surgeons here who can explain why the incisions for a laparoscopic nephrectomy are on the front of the abdomen? I would have assumed it would be easier to get to the kidneys via the back and/or side.
Not a surgeon, but I will answer since no one else has. By entering the abdomen from the front, the surgeon gets to the peritoneal cavity, which is filled with gas and the laparoscopy instruments are inserted into this space, this gives the surgeon room. The kidneys are behind this cavity. There are other ways of approaching the kidneys, eg from the flank but in general I think that involves making a larger incision.
That makes sense, thanks!
omg I hoped someone else would ask but would you describe the pattern touching more? Like what are the patterns, what does it feel like
also I'd like to report the urban legend backstory meme text was difficult to read for me in phone browser
I had something maybe similar as a child/young teenager. It was numerical patterns (e.g. if I touched something three times on the right, then I had to do it three times on the left). It got more elaborate, and therefore more troublesome, over time (e.g. three times right, three times left, three times right again; then switch to three times left, three times right, then three times left again. Maybe repeat that for a couple of sequences).
We had a set of coloured plates in the house, and when setting the table I would *have* to do "green plate, blue plate, green plate" and so on. I *couldn't* let it be two green plates or two blue plates in sequence. Silly things like that.
Eventually, as I said, it was getting to the point where I recognised that if I didn't do something, it would take over my life. So I broke myself of it by squashing the impulses and refusing to carry out the little rituals. It took time and it was hard, but it worked.
(This was before the days of "tell your parents, go to see a therapist, be diagnosed and treated for a disorder" in my country; at that place and time if I had said anything to anyone, it would have been "oh my God, you're insane, you're a lunatic, you will be sent to the asylum" in reaction).
It may sound funny to talk about setting out plates in colour sequence, and it is by one way of looking at it, but it wasn't funny to experience *having* to do what you know is meaningless for no reason.
thanks!
Hey, sounds familiar! It's not something I've commented on much over the years, but seeing someone else talk about just squashing the impulses- yeah. It was like an itch that would just get worse, but ignore it enough and it (almost) goes away.
I thought of it as "cultivated weirdness," as it became, for a brief time, a sort of socially-identifying quirk. But thankfully I came to recognize it as a fixable problem before it became too frustrating or became too much of a social trend to indulge that sort of thing.
Even years later, when I have a situation where doing something in a pattern could make sense but isn't necessary for external reasons- I usually avoid doing the pattern.
Someone else did ask, he addressed this in another comment.
omg where? I scrolled the whole thing I thought
https://www.astralcodexten.com/p/my-left-kidney/comment/42665784
Thanks! I'm still curious like, how it feels on the inside, but maybe that doesn't have a good answer.
Ever felt uncomfortable that a painting wasn't hung perfectly level, and you just have to put it right? Or see something out of order and you just have to rearrange it? Everyone has those experiences at a minor level, this is just a larger version of it.
that's just what I was looking for, thank you
I'm worried that this donation was made out of scrupulosity, which Scott of course has discussed in several posts. Scott's stated reasoning for donating:
> Everything else I try to do, there’s a little voice inside of me which says “Maybe the haters are right, maybe you’re stupid, maybe you’re just doing the easy things. Maybe you’re no good after all, maybe you’ll never be able to figure any of this out. Maybe you should just give up.”
This reminds me of Ozy's post on shame and scrupulosity: https://thingofthings.wordpress.com/2018/10/24/defeating-scrupulosity/
Now I know Scott has argued there's no link between EA and mental illness in general: https://slatestarcodex.com/2015/03/06/effective-altruists-not-as-mentally-ill-as-you-think/
But reading this just makes me feel sad. Like poor guy, he felt so bad about himself that he had to cut out part of his body and donate it to make himself feel worthy. Or as Scott put it in a different article (https://slatestarcodex.com/2015/01/01/untitled/)
> A better word for this untitlement is, perhaps, scrupulosity, where you believe you are uniquely terrible and deserve nothing. Scrupulosity is often linked to obsessive compulsive disorder, which the recent survey suggests nerds have at higher rates than the general population and which is known to be more common in high-IQ people. When I hear my utilitarian friends say things like “I have money and people starving in Africa don’t have money, therefore I am morally obligated to give half of my money to people starving in Africa or else their starvation is my fault” and then actually go and do that – and trust me, these people are always nerds – then as often as not it’s scrupulosity at work.
So maybe it was reasonable to turn him down for the OCD history after all.
I'm biased here. I don't think donating a kidney to a total stranger is a good thing. I share the intuitions of other commentors that it violates the moral value of Purity. And there's something disturbing about doing it for this reason. There's a story about someone who starves himself to death for EA purposes - I can't find it at this moment but I'm sure it's been posted in the comments on Scott's blogs before. This has that flavor to me, even if it's only a 1% chance of death. It's just too self-denying, in a visceral way - a knife is taking out one of your organs! (ok, probably a laproscope, but still.)
Basically, I think we should feel good about ourselves already - we shouldn't need to donate 10% or a kidney to get to that point. (https://slatestarcodex.com/2014/12/19/nobody-is-perfect-everything-is-commensurable/) And if we're not at that point, our resources should go towards ourselves, to fix that problem, rather than give up some part of our life.
It's fascinating how rightists' notion of morality often amounts to "aesthetics", while non-rightists' notion of morality is typically synonymous with "ethics".
Did you originally post this under a different name? It disappeared and then reappeared.
Anyway, I am confused - morality and ethics are synonyms. And the exact relationship of ethics to aesthetics is debated, but most people see being unethical as ugly - I don't see how this is a left/right divide. Can you explain?
> Anyway, I am confused - morality and ethics are synonyms.
One would think, but it seems some people don't treat them as synonyms. Or if they do, they're using an atypical definition of both words.
> I don't see how this is a left/right divide.
I have only seen this among people on the (cultural/social) right. Most noticeably among people on the far-right.
Seen what, exactly? Can you explain? How do people use those words?
In Roger Zelazny's "Lord of Light", when the hero comes back from being punished for a failed rebellion against the 'gods' of that world, he begins a new resistance by reconfiguring Buddhism and establishing a morality based on aesthestics:
"The answer, the justification, is the same for men as it is for gods. Good or ill, say the sages, mean nothing for they are of Samsara. Agree with the sages, who have taught our people for as far as the memory of man may reach. Agree, but consider also a thing of which the sages do not speak. This thing is 'beauty,' which is a word, but look behind the word and consider the Way of the Nameless. And what is the way of the Nameless? It is the Way of Dream. And why does the Nameless dream? This thing is not known to any dweller within Samsara. So ask, rather, what does the Nameless dream?
"The Nameless, of which we are all a part, does dream form. And what is the highest attribute any form may possess? It is beauty. The Nameless, then, is an artist. The problem, therefore, is not one of good or evil, but one of esthetics. To struggle against those who are mighty among dreamers and are mighty for ill, or ugliness, is not to struggle for that which the sages have taught us to be meaningless in terms of Samsara or Nirvana, but rather it is to struggle for the symmetrical dreaming of a dream, in terms of the rhythm and the point, the balance and the antithesis which will make it a thing of beauty. Of this, the sages say nothing. This truth is so simple that they have obviously overlooked it. For this reason, I am bound by the esthetics of the situation to call it to your attention. To struggle against the dreamers who dream ugliness, be they men or gods, cannot but be the will of the Nameless. This struggle will also bear suffering, and so one's karmic burden will be lightened thereby, just as it would be by enduring the ugliness; but this suffering is productive of a higher end in the light of the eternal values of which the sages so often speak.
"Therefore, I say unto you, the esthetics of what you have witnessed this evening were of a high order. You may ask me, then, 'How am I to know that which is beautiful and that which is ugly, and be moved to act thereby?' This question, I say, you must answer for yourself. To do this, first forget what I have spoken, for I have said nothing. Dwell now upon the Nameless."
Would you class Zelazny as a rightist? 😀
"I share the intuitions of other commentors that it violates the moral value of Purity."
Please excuse me, I'm rolling on the floor laughing (in Minecraft) here. I thought all this purity stuff was the realm of us knuckledragging conservatives who were way less morally shining bright than the open-minded liberals? That concerns with purity were tied up with the disgust reaction, which is anti-gay and anti-trans and anti- all the good values of current society?
Purity and scrupulosity are often coded with religiosity, and while someone would not be expected to go to this level of heroic virtue, especially if it was deemed to arise from an overweening sense of sinfulness or unworthiness and as an attempt to placate or 'buy off' God, it would indeed be seen as praiseworthy and virtuous:
https://en.wikipedia.org/wiki/Heroic_virtue
"In summary, heroic virtue is marked by the cardinal and theological virtues, encompassing faith's foundational role, hope's resilient trust, and divine charity's boundless love. Prudence, justice, fortitude, and temperance further contribute to the virtuous life."
By weighing up potential risks and taking them into account, Scott certainly had demonstrated prudence, and his explanation of his reasons does encompass justice, charity, and hope.
"HEROIC VIRTUE
The performance of extraordinary virtuous actions with readiness and over a period of time. The moral virtues are exercised with ease, while faith, hope, and charity are practiced to an eminent degree. The presence of such virtues is required by the Church as the first step toward canonization. The person who has practiced heroic virtue is declared to be Venerable, and is called a "Servant of God."
https://www.newadvent.org/summa/2061.htm#article5
"Again, since man by his nature is a social animal, these virtues, in so far as they are in him according to the condition of his nature, are called "social" virtues; since it is by reason of them that man behaves himself well in the conduct of human affairs. It is in this sense that we have been speaking of these virtues until now.
But since it behooves a man to do his utmost to strive onward even to Divine things, as even the Philosopher declares in Ethic. x, 7, and as Scripture often admonishes us—for instance: "Be ye . . . perfect, as your heavenly Father is perfect" (Matthew 5:48), we must needs place some virtues between the social or human virtues, and the exemplar virtues which are Divine. Now these virtues differ by reason of a difference of movement and term: so that some are virtues of men who are on their way and tending towards the Divine similitude; and these are called "perfecting" virtues. Thus prudence, by contemplating the things of God, counts as nothing all things of the world, and directs all the thoughts of the soul to God alone: temperance, so far as nature allows, neglects the needs of the body; fortitude prevents the soul from being afraid of neglecting the body and rising to heavenly things; and justice consists in the soul giving a whole-hearted consent to follow the way thus proposed. Besides these there are the virtues of those who have already attained to the Divine similitude: these are called the "perfect virtues." Thus prudence sees nought else but the things of God; temperance knows no earthly desires; fortitude has no knowledge of passion; and justice, by imitating the Divine Mind, is united thereto by an everlasting covenant. Such as the virtues attributed to the Blessed, or, in this life, to some who are at the summit of perfection."
Haidt did find that Purity was a value more appealed to by conservatives in the US than by liberals.
Not sure what you mean about conservatives being knuckledragging or bad, or who you're arguing against - did some commenter here say that?
Not on here, because thank God the level of discourse is generally higher, but it's the online general triumphalist tone of the more-inclined-to-the progressive side: "see, those dumb conservatives only hate gays/trans/whatever because they think they're icky, it's Science!"
https://pacscenter.stanford.edu/publication/gut-check-reappraisal-of-disgust-helps-explain-liberal-conservative-differences-on-issues-of-purity/
"Disgust plays an important role in conservatives’ moral and political judgments, helping to explain why conservatives and liberals differ in their attitudes on issues related to purity. We examined the extent to which the emotion-regulation strategy reappraisal drives the disgust-conservatism relationship. We hypothesized that disgust has less influence on the political and moral judgments of liberals because they tend to regulate disgust reactions through emotional reappraisal more than conservatives. Study 1a found that a greater tendency to reappraise disgust was negatively associated with conservatism, independent of disgust sensitivity. Study 1b replicated this finding, demonstrating that the effect of reappraisal is unique to disgust. In Study 2, liberals condemned a disgusting act less than conservatives, and did so to the extent that they reappraised their initial disgust response. Study 3 manipulated participants’ use of reappraisal when exposed to a video of men kissing. Conservatives instructed to reappraise their emotional reactions subsequently expressed more support for same-sex marriage than conservatives in the control condition, demonstrating attitudes statistically equivalent to liberal participants."
Liberals are reasonable, you see, while conservatives are emotion-driven and thus make irrational decisions.
Along with the studies on "Democrat voters are more educated" and the rest of it. So conservative = Republican = all kinds of bad things, generally dumb rednecks who hate science and know nothing. Conservatives are fearful and thus regard LGBT+, immigrants and the rest as threats. (The "bitter clingers", if you like):
https://www.huffpost.com/entry/obama-no-surprise-that-ha_b_96188
"And when he spoke to a group of his wealthier Golden State backers at a San Francisco fund-raiser last Sunday, Barack Obama took a shot at explaining the yawning cultural gap that separates a Turkeyfoot from a Marin County. "You go into some of these small towns in Pennsylvania, and like a lot of small towns in the Midwest, the jobs have been gone now for 25 years and nothing's replaced them," Obama said. "And they fell through the Clinton Administration, and the Bush Administration, and each successive administration has said that somehow these communities are gonna regenerate and they have not. And it's not surprising then they get bitter, they cling to guns or religion or antipathy to people who aren't like them or anti-immigrant sentiment or anti-trade sentiment as a way to explain their frustrations."
Obama made a problematic judgment call in trying to explain working class culture to a much wealthier audience. He described blue collar Pennsylvanians with a series of what in the eyes of Californians might be considered pure negatives: guns, clinging to religion, antipathy, xenophobia."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164548/
"Conservatives, however, are more likely to endorse binding foundations compared with liberals (van Leeuwen & Park, 2009) because these foundations help address motivations toward traditionalism (Malka et al., 2016), cognitive structure and closure, as well as to manage perceptions of threat, all things that tend to be found in higher levels among conservatives compared with liberals (e.g., Jost, 2017)."
(The above study is interesting and worthwhile to read, I just picked that excerpt to show what I mean).
Purity is linked with Authoritarianism, and we all know Authoritarianism is Bad:
https://journals.sagepub.com/doi/10.1177/10888683221124741
"Liberals and conservatives both care about sanctity, but just through different lenses. It is also the case that other factors, more so than purity might better explain variation in moral judgments between conservatives and liberals. Work by Kugler et al. (2014) suggests that higher levels of authoritarianism actually underlie the greater valuation of purity observed among conservatives versus liberals. Relatedly, it may be that greater preoccupation with specific taboos (e.g., being more offended by the use of expletives) is more common in conservatives versus liberals, and these specific concerns might be confused with broader concerns about purity. In other work, Schein and Gray (2015) found evidence across seven studies that perceptions of harm (more so than purity) explained moral diversity across the political spectrum. Differences in moral judgments between liberals and conservatives hinge upon what they each see as causing harm. Together, this work suggests that perhaps earlier claims about the uniqueness of purity to conservatives was exaggerated, perhaps as a result of using a priori conservative moral issues to construct a scale to measure purity (Graham et al., 2011)."
Again, a good study looking at "so what do we mean by purity, anyway?"
A long and detailed study from 2009 that included looking at religious liberals versus religious conservatives (I was amused by the contrast between the Unitarians and the (Southern) Baptists):
https://fbaum.unc.edu/teaching/articles/JPSP-2009-Moral-Foundations.pdf
"The results supported the moral foundations hypothesis: Liberals refused to make trade-offs on most of the individualizing items but were more willing to perform actions that violated the three binding foundations. Conservatives, in contrast, showed a more even distribution of concerns and reported more unwillingness than did liberals to accept money to act in ways that violate Ingroup, Authority, and Purity concerns. The results also challenged our previous finding that liberals care more than conservatives about Harm and Fairness issues.
Do these results show that we were premature in concluding, from Studies 1 and 2, that liberals care more about Harm and Fairness issues, on average, than do conservatives? We do not think so. Rather, we think there is a general across-the-board political difference on the permissibility of making moral trade-offs."
So mostly it was that the early studies were concluding "liberals are A and B, conservatives are X, Y and Z" and that got taken up and disseminated in a pop-culture way, melding in other studies, that "conservatives are all uneducated and driven by fear, disgust, and authoritarianism".
> I thought all this purity stuff was the realm of us knuckledragging conservatives
I think this is one of the parts of that book that has not aged perfectly. Just look at all the ads: "100% this, free of that, pure whatever, natural, organic, vegan, sustainable". Or the cancellations, shunning, divestment, and boycotts. There are some reasonable guesses as to what's going on - this is all associated with generic modern "blue tribe" progressivism, not the classical liberalism that he confuses with general leftism, and that composed part of the left during his formative years.
Maybe this is a small part of the shape of the "God-shaped hole". Or as I'd put it, our bio-neural-net brains evolved mechanisms to allow humans to bond together in groups, and movements that don't take advantage of all the mechanisms will in general be outcompeted by movements that do, including by having the movements that don't evolve variants that do.
Seems to me -- and at this point I'm irritable and not the least bit god-shaped -- that all this stuff about kidney donation being a violation of our sacred bodily purity and integrity is lipstick on a pig. People are experiencing disgust and anxiety at the thought of being knocked out & cut open, then having a relative stranger extract a slimy, bleeding gobbet of their internal organs. That's a totally understandable and normal reaction to the idea of surgery, and most people facing surgery have some version of it. We did not evolve in circumstances where procedure like that can be carried out with no pain and little danger. Consequently, even when we know that the incision and removal of the kidney will not be felt, and we are very unlikely to suffer serious harm, we are disgusted and horrified by the idea of kidney removal. Why try to turn this primitive but understandable reaction into Beethoven's Fifth?
I can somewhat sympathize with the notion of Purity, but I'm really curious about how that intersects with other values for you. Could you elaborate on where you draw the line for self-sacrifice? Many cultures consider laying down one's life for one's country to be extremely virtuous - does Patriotism also violate your sense of Purity?
Interesting point. I have similar concerns about someone pressured into military service, though that situation seems much less troubling probably because it's less personally invasive and more justified in that a country or cause is not a total stranger.
I'm not completely sure why that situation troubles me less.
I don't know how you would distinguish between being a moral person and being scrupulous even in principle, when you're talking about doing something supererogatory. I will say:
- I'm not usually scrupulous in other situations; for example, I'm semi-vegetarian, but will eat meat when vegetarianism is inconvenient or it looks especially delicious, and not worry about it. I only donate 10% of my income and feel no pressure to donate more.
- I feel good for donating, and I didn't previously feel guilty for not having donated
- When my ex-girlfriend asked me not to donate, I was willing to go along, and would have been willing to go along forever if we'd gotten married.
- I go on and off SSRIs every so often, and this doesn't change my interest in donating at all.
- I think of "everyone has a little voice inside of them that questions their decisions" as part of having a conscience or being human, and I'd be concerned if someone else said they had absolutely zero of this.
Oh man, SSRIs. I probably lost 40 QALYs from SSRIs due to PSSD (permanent genital numbness probably reduced / will reduce my quality 0.8 over 50 years). Still desperately searching for a cure and currently trying estrogen injections. I saw you commented somewhere saying you thought you might have PSSD - have you tried any cures or researched any?
Regarding the morality/scrupulosity distinction, did you see this comment?
https://open.substack.com/pub/astralcodexten/p/my-left-kidney?utm_source=direct&r=qvl82&utm_campaign=comment-list-share-cta&utm_medium=web&comments=true&commentId=42660720
Psychologist and OCD specialist Eremolalos identified several criteria to distinguish: (1) driven by a deep, fear of bad consequences if one does not do the behavior, (2) recognizing that the fears are irrational, (3) the rituals and worrying about rituals and bad consequences take up a substantial part of the person’s time and mental energy, to the point whero the person is preoccupied, (4) past history of OCD makes it more likely.
I'm glad to read in this comment that you don't feel guilt or pressure to be a more moral person - from your previous posts on scrupulosity and creepiness it sounded like you did at one point, so I'm surprised and curious when/if that changed. Did you ever write about that?
For me the relevant distinction is, does someone want someone else to be happy (which is healthy) or do they feel a sense of moral obligation, like they should give something up for someone else (unhealthy)?
As far as your last bullet point, that seems to be moving the goalposts quite a bit! The passage of yours I quoted was about an internal critic, a voice there for "everything else" you try to do that says "you're no good, stupid, you should just give up" which is not normal, healthy, or a conscience. That sounds like some pretty seriously negative self-talk and possibly a bit OCD.
>"you're no good, stupid, you should just give up" which is not normal, healthy, or a conscience. That sounds like some pretty seriously negative self-talk and possibly a bit OCD.
It does not sound like OCD at all. I have seen quite a number of people with scrupulosity, and the feeling that drives their scrupulous behavior is nothing like the self-esteem struggles Scott describes. These people are preoccupied with very specific, weird anxieties about the bad things that might happen if they do not carry out their required ritual behaviors often enough and correctly enough. They’re afraid to delete the televised masses they recorded and have not watched because then their nephew who’s on a trip might die in an auto accident. They’re afraid the sore spot on their scalp signals a brain tumor that developed because they were thinking irritable thoughts the last time they drove by a church. Stuff like that. People with scrupulosity actually hardly talk at all about the routine self-esteem issues most people do — things like is my nose too big? Am I just a people pleaser? Does my girlfriend think her ex was smarter than I am? People with scrupulosity don’t have mental space to worry about the small stuff, because they feel in grave danger of catastrophes, and are never sure their religious “observances” are copious and perfect enough to prevent them.
As for Scott’s negative self-talk. I don’t know whether it’s normal and healthy, exactly, but it sure is common. I certainly have thoughts like that at times, and so do my friends. Not many people make it to adulthood without some wounds that left scars that ache sometimes. My closest friend is;, by his own account, the most content he has ever been. He and I are very honest with each other, and he would not say that if it were not true. But there was an incident recently when someone we both know was inexplicably short with him, and he sent me a confused and unhappy text about it, commenting that “I find it easy to imagine that I am irritating.”
I think the best measure of health is not whether somebody is continuously happy and confident (does the state of the world even justify feeling that way?) but how somebody is doing in various important arenas of life. Work: do they enjoy it? are they good at it? are they making enough money? Friends: Do they have a circle of close friends they keep in touch with? Romance: Are they able to date? fall in love? are they married? is their relationship with their spouse good? Family of origin: etc etc. There’s a lot I don’t know about Scott’s life, but the impression I get is that in the main arenas things are at worst pretty good, and in some they’re excellent.
Sorry, I'm a bit attached to my parts.
Maybe it's my transhumanism. Permanently reducing my physical potential (even in such a minor way) just rubs me the wrong way. Also, I intend to live a very long time and I don't fancy removing a potentially necessary part of my body.
Agree completely. I have a very negative feeling about this and it feels wrong to me. I suspect the moral value of Purity or Sanctity is relevant here.
Speaking personally, I don't think my attachment to my body is due to concerns of purity. I'll have no problem introducing genetic modifications of all sorts once the technology allows. Sanctity on the other hand is an interesting choice of word. The whole "my body, my temple" thing is horribly cliche, but part of me does think that there's something almost miraculous about living organisms. Life is localized negative entropy, struggling to maintain itself against a universe that seeks to destroy it in a thousand and one ways.
I have this same intuition about my parts. I don't describe it to myself as purity or sanctity---more as integrity, the idea of remaining whole. I got a cadaver ACL, and wisdom teeth taken out, and they feel like violations of wholeness. I *KNOW* this whole-feeling isn't rational. I obviously wouldn't rather be limping around with impacted teeth. But after Scott's article, I looked into donating bone marrow and even 1/430 chance of donating 10% of my bone marrow is still bugging me. Heck, donating blood bugs me for the same reason, and I have donated blood.
I guess I'm just a bad person grasping for excuses as to why I'm not REALLY such a bad person.
I don't think you're a bad person at all, nor is anyone else with those feelings. "Don't remove parts of yourself that are necessary for maintaining homeostasis" strikes me as a VERY good heuristic and a feeling of discomfort whenever you do so strikes me as a very good instinct. Any organism which lacks a sense of the wholeness of its being and the importance of preserving that is probably going to die sooner than (and be outcompeted by) an organism that does.
That doesn't mean there aren't instances when going against that feeling is warranted. Perhaps even morally required. But IMO, the burden of proof is one those making the argument to disrupt the unified functioning of your body (which to his credit, Scott has attempted to do in great detail). Of course, I'm not a utilitarian. So what I consider burden of proof probably differs greatly from many of the people commenting on this article.
It is never morally required to give up part of your body. Ever!
It is morally required to give up part of your body if you've promised to give up part of your body and someone else has incurred costs as a result. E.g., if you join the bone marrow donation registry and are later found to be a match, the usual process is:
1. You are told that you are a match, and again asked "are you for sure going to donate your bone marrow now".
2. You answer "Yes, I promise I will do this"
3. The recipient undergoes radiation and/or chemo therapy to kill all of their existing (and cancerous) bone marrow. They will now die soon and badly if they do not receive bone marrow from a matching donor.
4. You in fact donate your bone marrow
5. Everybody lives happily ever after, with the usual caveats.
Somewhere in step 2 or 3, it does become morally obligatory for you to give up part of your body.
I don't think you're a bad person at all. Does it help any with the feeling around blood donations that your red cells will only last around 120 days before being efficiently devoured, so by donating you're likely just giving away some cells that are going to perish anyhow? To be crude, that it's more like excretion than losing precious bodily fluids?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006275/
"Normal human red blood cells have an average life span of about 120 days in the circulation after which they are engulfed by macrophages. This is an extremely efficient process as macrophages phagocytose about 5 million erythrocytes every second without any significant release of hemoglobin in the circulation."
https://www.mskcc.org/cancer-care/patient-education/facts-about-blood-and-blood-cells
"White blood cells have a wide range of lifespans, from hours to years.
The lifespan of platelets is about 9 to 12 days."
I've tried to talk myself into being comfortable with it using arguments like the following:
1. It's no different than a big nosebleed, and those don't bug me.
2. Hey, I can eat more calories!
3. I make new blood all the time.
And there's STILL something about letting Blood Truck Vampires bleed me out that feels like a violation of my wholeness. (To be fair, the one time I did it, they took almost 1.5 pints. I don't know how that's legal or within policy. We were all super-healthy physically active young adults, so the Blood Truck Vampires felt comfortable filling the second bag until the subject started to pass out. I came to a few seconds later, ate my cookie, and went back to work like nothing happened. And so did everyone else.)
Anyway, I'm B+. Blood Truck Vampires want my platelets much more than my blood. Their short lifespan DOES make the idea of donating them less icky. I'll look into it.
Listen, you're a way better person than me, because you do donate blood. I've never done it, despite other family members doing it, mainly out of squeamishness. If they could figure out some way to get my blood without me having to be there, I'd sign up in a flash.
But I'm terrible with needles, just the idea of sticking something into a vein makes me come over all faint, and I have problems when the doctor needs to do a blood draw (seemingly I have small veins or something so it's a five-alarm fire trying to get the one working damn vein to stand out, and then the blood to flow, and collect enough for the fifteen vials they produce, and then afterwards I have bruises and sub-dermal bleeding for days).
So good on you!
I would sue their ass... and you've convinced me to NEVER donate blood, unless I absolutely need to get rid of some for medical reasons (happens sometimes when you supplement lots of testosterone).
You are NOT a bad person. That is YOUR body and no one else has ANY right to any of it. Even if it would save their life, you have the absolute freedom to keep it, no matter what. No one else is getting any part of my body, even after I die.
This is another reason why kidney donation rubs me the wrong way - not only does it violate integrity, but it makes people feel bad for having this important value. I think that's ass-backwards - donating is bad, and wanting to keep your body is good.
Are you sure your aversion to giving a kidney comes from some deep and sacred place? Seems to me it's quite natural to feel anxiety and distress regarding most aspects of the procedure. Being knocked out, having strangers cut you open while you're helpless, blood, pain, injury, fear of death, idea of the sealed up, well-functioning torso being opened up and vulnerable to infection or harm. I felt all that stuff before I had some abdominal surgery, surgery in which nothing whatever was expected to be removed, and in fact nothing was. It didn't feel like it came from a spiritual place or a deep intuition. It felt like anxiety about surgery. We are, after all, wired by evolution to fear injury. We're wired to fear heights and bugs too, and in fact I hate flying and am afraid of spiders -- that doesn't feel a bit spiritual either. It feels like anxiety wiring.
Why not both?
There's obviously some anxiety and distress about it, and it is terrifying.
There's also very obviously a sacred value to bodily integrity.
I think it’s natural to be disturbed by harm to your bodily integrity. I once had a tooth pulled unexpectedly. There was little choice because the thing just fell apart while dentist was working on it, and so I said go ahead and pull out what’s left. But I did feel disturbed for a few days afterwards about a part of me being gone. Still, I don’t see any grounds for calling bodily integrity sacred. What does sacred even mean in this context? Apparently you think it means something more than “bothers me to have it compromised.” Why, though? I have a mild phobia of vomiting, and am quite disturbed when somebody vomits in front of me. Does that make vomit-free zones sacred?
In a way, yes. Purity or Sanctity is one of Haidt's moral values, and a space being clean or free of waste would go towards that value.
I'm not sure how to describe it, other than a powerful feeling of it being a terminal value, with a sense of awe or majesty?
I would have expected a transhumanist on average to be less squeamish about this than the random average person.
Who said I was squeamish? I'm a transhumanist because I desire to use technology to enhance and explore the possibilities of the human condition. Technology is nowhere near the point where I'd be able to replace that part with something equivalent or better. So why on earth would I choose to take an action which permanently reduces my physical capabilities?
FWIW, I'm also a transhumanist and I also feel the same way.
That's odd, since my impression of transhumanism is that becoming the superior machine version of you and discarding the squishy organic bits is all part of the attraction. If you intend to be a cyborg, a fully functional android, or have a custom-built dolphin or other species body you can plug your consciousness into, why feel qualms about giving up a kidney that you don't intend to *need* in the Glorious Fully Automated Luxury Gay Space Communism future? If you want a kidney then, the AI can just print fifty out for you!
(There's also a "bioengineering" aspect to transhumanism. Custom bodies, fresh from the vats, tailored to your specifications!)
I'll admit to an aesthetic preference for biological enhancements over mechanical, but I'm certainly not opposed to the latter.
Transhumanism isn't necessarily wedded to the idea of mechanical augmentations. It's about using technology to enhance your physical and mental capabilities. Taking an action which permanently reduces my body's functioning is directly opposed to that.
As far as the Fully Automated Luxury so on and why I worry about a kidney when the AI can just print me a new one, the rather obvious answer is that currently the AI can't print me a new one. The technology for truly replacing human organs is nowhere near maturity (if it were, we wouldn't be having a debate about the need to donate them) and no one knows when it will be ready. Given that, I prefer to hedge my bets and hang on to the parts of me that allow my body to maintain homeostasis.
Even if we get to the "living a very long time" beyond current human lifespans, that will necessitate removal and replacement of worn-out existing organs, or some kind of adjustments to the organs you possess, in order that they remain functional.
Not to be morbid, but you might also die before ever that time when "we can live to be two hundred!" comes, and your intact organs will go into the grave with you.
But that sounds like I'm trying to push you to donate, and I'm not; you are entitled to say "no, thanks". Just that transhumanism seemed an odd motivator for that stance to me.
Regarding the gap between people who said they would donate vs who do: I think it's like the Peter Singer analogy of saving a drowning child in the forest. If you are the ONLY one present, most people would try to save the child. But if there are millions of children at risk and billions of people who are in a position to save them, there is almost no pressure on you. Similarly, if someone come to you and say: "you are the only match for this person, please give them a kidney because no one else can", about 50% of people are honest in the survey that they would donate in those circumstances. But not in real world circumstances.
It is good to know that friends and family get priority, that was one of the things holding me back before, I will check out my local organization and consider donating more seriously as a result of reading this information. Thank you!
Oddly enough, the rebuttal to the Drowning Child argument came to me last night - Thomson's Violinist:
"You wake up in the morning and find yourself back to back in bed with an unconscious violinist. A famous unconscious violinist. He has been found to have a fatal kidney ailment, and the Society of Music Lovers has canvassed all the available medical records and found that you alone have the right blood type to help. They have therefore kidnapped you, and last night the violinist's circulatory system was plugged into yours, so that your kidneys can be used to extract poisons from his blood as well as your own. [If he is unplugged from you now, he will die; but] in nine months he will have recovered from his ailment, and can safely be unplugged from you."
Since we have already established the principle that the less developed organism has fewer rights than the most developed organism (the rights of the mother, as a fully developed human being, outweigh any putative rights the foetus may have), and since I, being a fully grown human adult with all my brain etc. systems at peak development, am therefore in possession of all full human rights, my rights outweigh those that the Drowning Child may possess.
As an undeveloped human, the Child has only potential or partial rights and does not yet possess full personhood, unlike me. Thus, as in the Violinist experiment, I am within my rights to prioritize my own personal convenience over saving a drowning child. I may feel that my expensive suit is worth more to me, or is more necessary for my needs, than any value saving a drowning child and ruining my suit may produce. Perhaps I need my suit for work? Valuing uninterrupted work and thus my economic welfare over the potential person life is an acceptable reason for abortion, so it's acceptable for the case of the drowning potential person life here as well.
I'm not sure I am convinced by the Violinist argument. If that argument stands, a conjoined twin would have the right to demand to be separated from their weaker sibling even when the surgery would surely kill the weaker twin. And no one in the world would agree such a seperation surgery would be ethical. I'm not arguing against bodily autonomy, mind, I'm just saying the Violinist argument doesn't work in real life conditions.
I don't accept it myself, but I do find it amusing that the same philosopher who accepts the right of parents to abort a pregnancy (and even simply as a thought-experiment, to commit infanticide up to the age of two years old) constructed an appeal to the heart-strings and not the reason with the Drowning Child: "you'd save a child, wouldn't you? you're not a bad person, are you?"
Well, if I have the right to kill my own child for my personal convenience, why am I obligated to save a stranger's child? Why does that make me a bad person if I don't do it?
The Violinist argument is on the pro-choice side, so that's fighting them with their own weapons. As I said, I think it's a terrible analogy, just slightly better than the other one Thomson uses, the Dandelion Seeds one (imagine if you could get pregnant by people seeds that float around like dandelion seeds, and even if you put up screens to keep the seeds out - the correspondence with contraception - yet one gets through and knocks you up, surely all will agree that you have the right to an abortion there!)
As you say: that's not how it works in the real word.
"the right to kill my own child for my personal convenience"
See, this is why pro-choicers find pro-lifers exasperating. Nobody is talking about "the right to kill my own child for my personal convenience." An embryo is not a child! It's not a sentient being. It cannot feel or think, the way a (born) child can. Now, of course, when you abort an embryo, you deny it the chance to become a sentient being. I think that's sad, and I agree with former President Clinton who said that abortion should be safe, legal, and rare.
In my ideal world, everyone who wants to have sex and not have a baby would use effective contraception 100% of the time, and the few (legal) abortions would be reserved for a) people whose contraception failed (it happens even if you do everything right), b) women who got pregnant due to rape, c) women who needed an abortion due to health complications.
And this is why pro-lifers find pro-choicers exasperating.
"An embryo is not a child, it's just a clump of cells!"
"A foetus is not a baby!"
So when does it become a baby? "When/if the mother wants the pregnancy, otherwise it's not anything except 'the products of conception' or similar terms".
Bill may have invented the phrase, but Hillary was the one riding the "safe, legal and rare" mantra until the focus groups said "drop the 'rare' bit, that's shaming women who have abortions":
https://www.latimes.com/opinion/opinion-la/la-ol-hillaryclinton-abortion-campaign-20160209-story.html
https://www.washingtonpost.com/outlook/how-democrats-purged-safe-legal-rare-from-the-party/2019/11/15/369af73c-01a4-11ea-8bab-0fc209e065a8_story.html
Abortion only for rape, incest or threat to the life of the mother? Funny, you'd *think* this would be an acceptable compromise option - until the rubber hits the road and then oh boy yeah there should be no limits and no punishment.
Case Number One from the UK: Woman breaks the existing law, terminates viable pregnancy, gets very mild jail sentence - and gets it overturned on the back of a wave of protest about how this is back to the Dark Ages and forcing women to backstreet abortions etc etc etc.:
https://www.theguardian.com/uk-news/2023/jul/18/carla-foster-woman-jailed-obtaining-tablets-pregnancy-freed-appeal
"A woman who was jailed for terminating her pregnancy after the legal time limit during lockdown will be released from prison and reunited with her children, after winning a court of appeal effort to reduce her sentence.
A court of appeal judge said Carla Foster, 45, needed “compassion, not punishment”, saying her 28-month sentence would be reduced to 14 months and suspended.
Sentencing her last month, Mr Justice Pepperall said Foster would serve half her term in prison and the rest on licence after her release, after she admitted illegally procuring her own abortion when she was between 32 and 34 weeks pregnant."
Remember, this is at 32 weeks of gestation, which means the 'embryo', I'm sorry 'foetus', no I mean 'the contents of the womb' looks like this:
https://www.whattoexpect.com/pregnancy/week-by-week/week-32.aspx
Case Number Two, Nebraska of this year, where a woman was sentenced under the repressive mediaeval religious bigot laws for procuring abortion for her daughter two years ago:
https://apnews.com/article/abortion-charges-nebraska-sentence-36b3dcaadd6b705ca2315bc95b99bdc1
"A Nebraska mother who pleaded guilty to giving her teenage daughter pills for an abortion and helping to burn and bury the fetus was sentenced Friday to two years in prison.
Jessica Burgess, 42, pleaded guilty in July to tampering with human remains, false reporting and providing an abortion after at least 20 weeks of gestation, which is illegal in Nebraska. Madison County District Judge Mark Johnson sentenced her Friday to one year in prison for each count, with the first two to run concurrently. The sentence for the abortion count was ordered to run after the first two, amounting to a two-year sentence."
Clearly the MALE judge is just a sexist pig bigot who wants to punish women for their sexuality:
“I shudder to think, Ms. Burgess, that you have such disrespect for a — call it a human fetus, call it a stillborn child — that you would treat it like yesterday’s trash and not give it some respect in its treatment and disposal,” the judge said. “Our society expects more; it demands more.”
I mean, it wasn't a *child*, as you point out, drosophilist: "it's not a sentient being, it cannot feel or think the way a (born) child can". With such positively Stone Age views held by the men in power, what can one expect? When will the values of a civilised society ever prevail?
"During the legislative session that ended in June, Nebraska lawmakers who opposed Republicans’ efforts to severely restrict abortion access repeatedly cited the Norfolk case, saying it shows state prosecutors would target women who seek abortions for criminal prosecution."
Exactly. Any kinds of limits or interference with the private decision between a woman and her healthcare provider is going to lead to witch hunts by the bigots and zealots.
And back in 1988, abortion was a blessing which served as "a significant expression of her ability to maturely achieve a status of healthy independence":
https://pubmed.ncbi.nlm.nih.gov/12283879/
And back a while, an Episcopalian dean pronounced that abortion was indeed a blessing, not a tragedy:
https://lib.tcu.edu/staff/bellinger/abortion/Ragsdale.htm
"And when a woman becomes pregnant within a loving, supportive, respectful relationship; has every option open to her; decides she does not wish to bear a child; and has access to a safe, affordable abortion – there is not a tragedy in sight -- only blessing. The ability to enjoy God’s good gift of sexuality without compromising one’s education, life’s work, or ability to put to use God’s gifts and call is simply blessing.
These are the two things I want you, please, to remember – abortion is a blessing and our work is not done. Let me hear you say it: abortion is a blessing and our work is not done. Abortion is a blessing and our work is not done. Abortion is a blessing and our work is not done.
I want to thank all of you who protect this blessing – who do this work every day: the health care providers, doctors, nurses, technicians, receptionists, who put your lives on the line to care for others (you are heroes -- in my eyes, you are saints); the escorts and the activists; the lobbyists and the clinic defenders; all of you. You’re engaged in holy work."
Hallelujah! But it's us pro-lifers who are the inconsistent ones, right?
Oh yeah, and if you don't want to carry out abortions, then don't go into medicine:
"But let’s be clear, there’s a world of difference between those who engage in such civil disobedience, and pay the price, and doctors and pharmacists who insist that the rest of the world reorder itself to protect their consciences – that others pay the price for their principles.
This isn’t particularly complicated. If your conscience forbids you to carry arms, don’t join the military or become a police officer. If you have qualms about animal experimentation, think hard before choosing to go into medical research. And, if you’re not prepared to provide the full range of reproductive health care (or prescriptions) to any woman who needs it then don’t go into obstetrics and gynecology, or internal or emergency medicine, or pharmacology. Choose another field! We’ll respect your consciences when you begin to take responsibility for them."
If I was the victim in the Violinist scenario, I'd let them proceed with saving his life, but still press charges for kidnapping. If I was a member of the Society of Music Lovers, I'd ASK the One Eligible Donor first, and if he said no, and we decided to kidnap him, I'd turn myself into the police afterward, and throw myself on the mercy of the court.
I think it is a cost argument. A lot of people would argue that 9 months + 18 - 21 years is not a fair sacrifice to demand someone else to make, but wet clothes are a fine sacrifice and we'd all think worse of you for not saving a life if the only cost was wet clothes.
The question is where the line gets drawn. Obviously, no one would blame you if you left the child to drown because there's someone who would shoot you at point blank range if you tried to rescue the child. This implies that you should not sacrifice your own life to save this child, if you do, that's way above and beyond what the correct thing to do is. But if the only risk is that your clothes would get wet and you'd catch a cold, then yes, everyone would judge you. If the risk was that you'd be late for work and lose your job? Hmm. That's fuzzier. My intuition is people would disagree there.
If to save this child, you would have to take on chronic illness for 9 months and then sacrifice personal autonomy and income on the pain of the law for decades afterward? There's evidently disagreement, but I still think I'd be fine not saving the child if it would put me in horrible debt for decades after.
Yeah, the problem with the drowning child analogy is that it ignores proximity and community, which do matter. Someone right there in front of you has a connection with you, some random people dying in shithole countries don't.
Just came here to say that this is awesome man. Being willing to let go of an important body organ is selfless and noble. You valued action over talk. You loved your "neighbor" (a stranger) as yourself. You cared for someone in a massive, humble, and anonymous way. Good on you.
1000% agree on financial incentive for kidney donation (as well as other organs in need, or even blood when in need). This would solve many issues in this realm, and save government/insurers massive many X in the long term.
EDIT: Financial incentive in the form Scott proposes, such as tax credit, seems like a good way to do this, as opposed to cash
"1000% agree on financial incentive for kidney donation (as well as other organs in need, or even blood when in need). This would solve many issues in this realm, and save government/insurers massive many X in the long term."
Not necessarily; the blood transfusion scandal in Ireland (actually, we've had a couple of scandals) and the UK was in part because commercial blood products from the USA, where being paid for blood donation happened, were used for treatment of haemophiliacs:
"Most of the blood products used by the BTSB were from local donations. However, some of it came from American suppliers which included blood from prisoners and drug addicts, who had a high risk of infection."
That's separate from, but included with, the Hepatitis C scandal (blood from a woman who had contracted jaundice caused by Hepatitis C was used to make anti-D human immunoglobulin for the treatment of rhesus negative (blood type) mothers.
https://en.wikipedia.org/wiki/BTSB_anti-D_scandal
"In 1994, the Irish Blood Transfusion Service Board (BTSB) informed the Minister for Health that a blood product they had distributed in 1977 for the treatment of pregnant mothers had been contaminated with the hepatitis C virus. Following a report by an expert group, it was discovered that the BTSB had produced and distributed a second infected batch in 1991. The Government established a Tribunal of Inquiry to establish the facts of the case and also agreed to establish a tribunal for the compensation of victims but seemed to frustrate and delay the applications of these, in some cases terminally, ill women.
This controversy also sparked an examination of the BTSB's lax procedures for screening blood products for the treatment of haemophilia and exposed the infection of many haemophiliacs with HIV, hepatitis B and hepatitis C."
The related scandal in the UK came, again, from use of commercial blood products from the USA:
https://en.wikipedia.org/wiki/Contaminated_blood_scandal_in_the_United_Kingdom
"n the 1970s and 1980s, a large number of people – most of whom had haemophilia – were infected with hepatitis C and HIV, the virus that leads to acquired immune deficiency syndrome (AIDS), as a result of receiving contaminated clotting factor products. In the United Kingdom, these were supplied by the National Health Service (NHS) with many of the products being imported from the US.
...People with haemophilia were principally infected via the plasma-derived product known as factor VIII, a processed pharmaceutical product sourced from the United States and elsewhere. The creation of such products involved dangerous manufacturing processes. Large groups of paid donors were used (as many as 60,000 per batch, and including prisoners and drug addicts); it only required one infected donor to contaminate an entire batch, which would then infect all of the patients that received that material.[In contrast, this was at a time when the practice of paying donors for whole blood in the United States had effectively ceased; the UK did not import whole blood from abroad, but it did import large quantities of Factor VIII given to those infected (as described in the documentary Factor 8: The Arkansas Prison Blood Scandal). The principal reason that the UK imported these products was that it did not produce enough of its own, and efforts to achieve self-sufficiency were inadequately funded."
Paying people for donating organs may increase supply, but it also increases risk: people who really need what (for the better-off and healthier) is a small amount of money will be people in bad situations and thus at more risk of poor health and things like drug addiction etc. If you make the rewards *too* high (to attract the middle and upper people) then you make the entire process too expensive so the poorer can't afford it; if you make the rewards smaller, the healthy college students who sell their eggs won't be interested and you will get the drug addicts, prisoners, people in rust belt trailer parks who literally have nothing to sell but their bodies, etc.
That's fair. I guess I should have specified the way Scott proposed, something like a tax credit over a certain number of years, as opposed to explicitly cash.
That's probably the best way to do it. The tricky part is that the people who would most benefit from a cash lump sum are going to be also vulnerable in other ways so it is a form of coercion (not just 'have you sold all your spare goods to raise cash' type thinking of means testing but 'have you tried selling a kidney/other organ?') and the people who would do best from tax credits may not want or feel able to donate.
Treating all deaths as 'opt-out' organ donations may tackle this problem of pressured incentives, but then again those organs may not be very useful (e.g. died of old age, died of illness/long standing disorder and so forth). Never mind family objections and maybe the death happening not in hospital so the organ harvesting team can't get there fast enough to preserve the organs.
Whatever we do, there's going to be some downside. That doesn't mean it's not worth doing.
the tax code ins't magic... it's still selling organs, which I assume has legal and moral downsides?
No it's not magic, but at least it then applies to people that make an income. I do think there are still downsides, but I think it's the least bad of all the options we have now. Once kidneys (and other organs) can reliably be made in a lab, this would obviously be unnecessary.
Security guards and gun control are effective measures to prevent school shootings, but so are structures that assure low-threshold contacts for students with troubles with their family or with bullying and while the first might be necessary, the second addresses the problem at an earlier level. On a similar side „making everyone eat healthy and exercise“ doesn’t work if we try to force people to do stuff without changing existing structures. People who have to struggle for their existence tend to chose the path of least resistance, so if the path if least resistance is fast food and cans, they will chose that. However, if we create a path if least resistance that allows people to be healthier on the side, it’s not like they will object. You can improve people‘s health by how you design cities, by making it easy to access structures of every day life (stores, schools, work) on foot or by bike. In Europe there’s another good example in the field of organ donation. In Austria your organs can be used after your brain death by default, unless you disagree, whereas in Germany you have to actively declare that they can be used. Obviously more people are organ donors in Austria, because to actively disagree, you have to mentally engage with the topic and that’s uncomfortable, so not disagreeing is the path of least resistance.
I honestly don't understand why Austria's method isn't used more. I'm totally behind the idea of opting out of organ donation; people should have that freedom. But minus the optout, the dead don't need their organs anymore, why not routinely harvest them for those that DO need them?
NOTA sound much better than nothing, and if the options are NOTA or nothing we should all push NOTA.
But I wonder if NOTA is better than opt-out organ donation by default for everyone in the country. Either in terms of outcomes if each were implemented, or in terms of political feasibility.
My own impression of the situation is that opt-out donation would solve more problems faster, and I like the ethics of it better (financial incentives are always going to be distortionary on other things, given how central money is to all of our systems and incentive programs).
But maybe NOTA is easier to pass politically because it's a tax cut and everyone likes those? Or something about what section of law would have to be changed and how much attention it would get?
Knowing very little about this area, I just wonder if the much smarter and better informed people pushing NOTA have a standard spiel or link I could read about why put effort behind that instead of opt-out. I would love to learn whether I should be changing my standard rhetoric on this topic.
There's not good evidence that an opt-out system increases the number of donors (Nudge led us all astray!) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128443/#:~:text=The%20paper%20concludes%20that%20there,out%20countries%20(4.8%20PMP).
Weird question but, could you say what was the weird pattern you use to touch objects as a kid? Curious cause I used to do that too! In my case the pattern was like A B, then B A - out of some vague sense of "fairness" to object B, so it can go first as well. But now B was first second, which is still not fair, so let's do one inverted round, B A A B. But it's still not 100% symmetrical, so you go B A A B A B B A, but then... Yeah, it was a recursive pattern that could go forever which was, uh, a problem at times.
Recently I found out that this pattern actually has a name, Thue–Morse sequence (OEIS A010060), which I thought was super cool.
Mine was also symmetry-based, but I think I just did the first iteration. But it would also involve "grounding" energies, so if something happened the opposite of the way I predicted I might touch the floor, or if I accidentally touched a man I might accidentally touch a woman to neutralize it, or things along those lines.
This was exactly me. At one point I got to 8 levels of recursion. Then somehow I just stopped doing it.
"Yeah, it was a recursive pattern that could go forever which was, uh, a problem at times."
That was me, as well. It got to the point that I decided if I don't stop this dead in its tracks now, I will become totally non-functional because I'll be spending large chunks of time keeping the pattern going.
Thank you for the name, at least if I'm nuts I'm not the only one crazy in the same way; misery loves company!
Out of curiosity, did your pattern-matching have to be done in a certain rhythm, that is, to a beat or cadence, and if that got disturbed, have to start over again?
Uh, just found out I actually got a bunch of replies to this and Substance didn't notify me. Sorry for the late response!
But no, I don't remember any rhythm component to it at all. Which is good, because after a couple of levels of recursion it got pretty hard to do it!
But interestingly, I stopped in pretty much the same fashion. At some point I just had a pep talk with my then ~10 yo self saying dude, you have *got* to stop this because it's actually becoming a bit of a problem. Against all odds, it somehow worked, and the urge to do it went away.
I had a thing like that too as a kid! Mine was ab, then ba to make it even. Then treating the whole block as a unit, I’d do it’s opposite number:Baab. Then I treat everything done so far as a block and do it’s opposite number. And so on, thru many many levels. Would try to see how many levels up I could get without getting confused.
The activity didn’t have a compulsive feel to it though — it was more a mental twiddle that I found soothing.
Congratulations Scott. You did a very good thing.
About a year and a half ago I seriously considered donating. I went through the screening and got approved to donate. During the screening process a doctor mentioned a study about post-operative pain, which I believe was this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790588/
IIUC, the study reports that ~1/20 donors reported chronic pain (that they self-report is due to the operation) years after the operation, and that those that do report a significantly decreased quality of life. The study doesn't have any controls, so it's possible that this is mostly due to the donors being mistaken about the pain being caused by the surgery.
That study gave me enough pause that I so far have not gone through with the donation. Scott, or anyone else, curious to hear your thoughts on it.
Hm. When I query my instinctive emotions (as opposed to a more rational system of ethics), I can say that I'd jump at the chance to donate a kidney (to start a chain) if a close relative or close friend needed one, but that this falls off rapidly the less I know the person and the less I interact with them on a daily basis.
However, if I happened to know the single bit of information that the person in need had previously donated a kidney to a stranger, that instinct goes right back up to somewhere around second-cousin-whom-I-never-see level, which is roughly "answer yes within 1 minute, but it'll take about 30 minutes before my emotions are fully on board".
I suppose this shouldn't have been a surprise given my instincts around reciprocity, but it was shocking to feel that switch flip, even in a hypothetical.
Does anyone else feel this way?
I kinda feel the opposite intuition. It would just be so inefficient to donate a kidney and then receive a kidney donation. It feels bad.
Think of it as a loaner! You end up with three alive people at the end of 7 years with 3 working kidneys in total, instead of two alive people.
Yeah, but sometimes life is inefficient. If I had two cars, and gave one to a friend who needed one, and then my remaining car broke down, I'd feel foolish, and a bit embarrassed if someone else gave me their spare car. But at the same time, it's just a bit of time-and-place-shifting, as though the third person gave my friend their car instead of me.
I'm considering kidney donation at some point in the future because of this article, but my mental health history is much more recent and stigmatized than yours and I think there's a decent chance I'll be rejected. Hell, there's a chance they'll view my desire to donate as a sign of mental instability. But, I will research it more and talk to friends/family/my psychiatrist/my priest (yeah, not very Rationalist of me) about the idea and maybe fill out that form in 6 months or so.
But the idea of kidney donation did remind me that I've always meant to donate blood but never got around to actually doing it. The one time I actually made it to a donation center I walked up 4 flights of stairs to get there and was rejected for a high "resting" heart rate. So I signed up to donate blood tomorrow and I'm going to try to be a regular blood donor even if kidney donation is off the table.
Just one data point, but I lost a kidney to cancer 23 years ago with no ill effect so far at 81 years old. Ther is noting I do or do not do because of having just one kidney.
Good for Scott!
This is so admirable!
I could never do it, out of a visceral (so to speak) terror of surgery. Another word for this is cowardice. Glad not everyone is a coward.
I find this absolutely admirable, I wish I eventually grow up to such selfless courage. However the more I think about it the more I run into a conceptual issue.
The thing is, I care about animal suffering almost as much as I care about human suffering. And I fear that by giving a kidney to a random person, the chances that they are a carnist are overwhelming. As a pure counterfactual, my action of saving this person will then cause immense suffering, potentially 10 to 20 years of daily contribution to the torture of conscious beings. I wonder if others have thought about it this way?
I've had the exact same thoughts. This line of reasoning (abstracted away from the particular example of organ donation) is discussed in this paper: https://journalofcontroversialideas.org/article/2/2/206.
This concern is, as the linked paper notes, "far less plausible in poorer parts of the world" where human lives are just as valuable but cause far less suffering to animals due to lower meat consumption and due to less of the meat consumed being from factory farms. And the parts of the world in which we can save the most lives with our donations are also among the parts of the world in which the marginal life saved causes the least animal suffering, so I feel able to continue my anti-malaria donations without worrying.
For myself (in my early 20s), I think I've decided to delay donating a kidney because either (a) American meat consumption will decline over the next 20 years and donating a kidney in my late 30's/early 40's will be morally preferable to doing it now, or (b) American meat consumption won't decline and I'd be uncertain about donating a kidney at any point in time.
I briefly considered traveling abroad to donate a kidney to somebody who causes less animal suffering than the average American, but I imagine global variation in healthcare systems would mess up the (human) QALY calculations that make kidney donation appealing in the first place.
Thank you, interesting to know that others have thought about it! Your approach seems very reasonable, although I do not share your optimism about the future.
I hadn't thought of this, but I agree it's a complicated situation. I can't find anything on whether conditional donation (eg only to vegetarians) is allowed, but knowing bioethicists I expect it isn't. Your best option would be to find some specific vegetarian who needs a kidney and make a deal to give it to them. I don't know where you'd do that search, though.
https://www.smbc-comics.com/index.php?db=comics&id=2624
Text of cartoon: Ethics gets weird when you try to account for future results
Lives saved by Batman = B
Therefore, Lives saved by the people who killed Batman's parents = (B - 2)
May I say that I do not understand the mindset of people who will justify abortion, euthanasia, or as here denying life-saving treatment to meat-eaters, but who then worry about poor little shrimps might have the sads?
https://www.shrimpwelfareproject.org/are-shrimps-sentient
Animals are not humans. Humans, like "women and children first", get preferential treatment. If you don't want meat-eaters to survive, nobody is asking you to donate blood or tissue or bone marrow or organs or any other thing. Let the sick and the homeless starve and perish, because they might have eaten a burger some time! Spend all your time, emotional effort, and money on the puppies and kitties and shrimp and moo-cows and baa-baas! You are entitled to care about what you want to care about, and not care about what you don't want to care about (after all, I've said the Drowning Child argument is unconvincing to me).
But spare *me* the Sarah Bernhardt performance over "oooh, by anonymously helping a fellow human-being I may be contributing to the torture of conscious beings". If ever my organs are usable after my death, I'm certainly not going to put any conditions on "I don't want them going to annoying vegans, make sure the vegans die first, okay?"
Such an aggressive answer... Why are you so triggered by my comment?
Anyway, as far as I can tell, we are talking about ethics and lucidity here. The whole premise of giving your kidney to a person you have and will never meet implies that you are able to see beyond your intuitions and question what really is good and bad. Go beyond the evolution programming that makes you care only about your family and tribe. In that optics it is perfectly justified to introduce more conscious beings into the picture than only the ones that look like you or are as intelligent as you. Ethics and lucidity.
Back to the aggressive tone, I would recommend that you take a moment to analyse your immediate reaction to my message, and to veganism in general. I used to have the same kind of reactions before I was vegan and one day I realised it was a defence mechanism.
The things that trigger us can be very telling.
Love and Kindness
Your purity of donation motivation reminded me of something, people who previously had also insisted on pure untainted donation systems where only the 'right' sort of people received their due.
Black blood and white blood in Johns Hopkins Hospital:
https://lowninstitute.org/lessons-from-lown-the-story-of-white-and-colored-blood/
"Working in the blood bank, I immediately confronted a conflict in values. Black blood had to be kept apart from white blood. This was especially galling since apartheid in blood had no scientific basis. Yet it was being practiced in one of the leading medical schools in the country, an institution that prided itself on being a pioneer in promoting science-based medicine while it distinguished donated blood with tags labeled either C (for “colored”) or W (for “white”)."
Apartheid-era South Africa:
https://journals.co.za/doi/pdf/10.10520/EJC68879
"Blood transfusion services in South Africa were required by law to collect the blood of people belonging to these different racial/ ethnic groups in separate facilities; the ‘race’ of the donor had to be stated on each unit of blood. The various racial/ethnic categories are associated with a range of other variables, causally and incidentally, and can sometimes serve as a substitute for other variables (such as HIV status) although, in the view of many people, the use of race/ethnicity for the profiling of blood donors is considered to be a stigmatisation of black donors."
Perhaps, under the enlightened guidance of you and those of like minds, a similar system could be implemented: a neat label of "V" for "Virtuous Valiant Vegans" and "C" for the "Cruel Carnist Cannibals"? That would solve the problem of your precious bodily fluids being used to save the lives of the unworthy!
Though this has, at least, presented me with a new rebuttal for the Drowning Child Argument: that child may eat meat, thus by saving them I would be permitting them to grow up and continue to eat meat and torture all the innocent little animals. So I should let them drown and work on saving the shrimps and the flies and the rats instead!
I understand your emotional reaction now. Of course this has nothing to do with my argument, I am completely disinterested in who is the person that receives the donation. I only care about consequences in terms of suffering. Do you get the difference? (I don't mean any aggression or condescendance in this question)
"I am completely disinterested in who is the person that receives the donation"
"And I fear that by giving a kidney to a random person, the chances that they are a carnist are overwhelming."
Does not compute, but then I'm not the one going "Love and Kindness" and also "I would prefer to let people who don't share my values die".
Again, I do not care if they do not share my value. Only consequences. Let me try to rephrase another way. The person could be a serial killer, or a nazi, I would not care. Their suffering matters as much as anyone's. What matters to me is what they do with the rest of their life. If they are going to make other people suffer then no I don't want to give them my kidney. If they don't then yes. Consequences. Do you get it ?
"Caring only about consequences in terms of suffering" is a very derision-worthy moral system because it is subject to many know paradoxes. For example, given any individual shrimp, you should either kill or castrate it immediately, as otherwise it will procreate other shrimps who will , undoubtedly, suffer before their death, but will also procreate other shrimps. At an infinite time horizon a single non-castrated shrimp that you leave alive creates infinite suffering!
If you dislike suffering, there is no either/or.
You can both pull a man from a burning building and work to promote animal welfare. You want to stop all suffering and that means you act when you can and you refuse to view it as a cosmic scale sort of thing.
i mean of course people have limits but the only correct answer to the trolley problem is "i want to save everyone!" You reject the cosmic scale because the scale is about balance or maximization not suffering itself.
if you read Out of the Silent Planet by C.S. Lewis, Weston is perfectly happy to capture Ransom and offer him up to the Oyarsa as a sacrifice as a greater good for Man, but upon questioning Man is barely an idea to him. He'd do any evil for the wispy idea of Man as essence not creature: as long as something survives anything is justified. break lives to save Life.
The mindset should be unified though. Weston is always a danger.
But real life presents us with versions of the trolley problem all the time. You can chant "I want to save everyone" all the fucking time if you like, but that won't keep you from being the person who either makes one of the possible choices on the trolley problem or walks away from the trolley and its possible victims and lets their fate be decided by luck or other people.
no, real life always has more options. philosophy sucks when it thinks artificially constrained hypotheticals have anything to say about real-world morality. its just "when did you stop beating your wife?" but expected to be taken seriously.
the only answer is to reject the silly framing entirely; human experience is not full of trolley problems because life isn't a/b.
Banned for one month for this comment.
If there's some form of appeal possible, I'd like to make one for Gunflint. This comment is like an optical illusion, or perhaps a "scissor statement" (thank you); when I look at it from one angle, it seems harsh and mocking, but when I look at it from another, it seems like a genuine expression of bafflement. I think Gunflint has been one of the more humane and calm commenters here, and I don't think they would have intended this comment to come out as harshly as I can make it seem when I try to adopt a perspective more like rational_hippy. I feel as though a warning or a single-digit-day ban would have been more appropriate. I don't want to have a repeat of Carl Pham's continuing absence.
I'm going to omit my interpretations of the comment, because I don't think they're worth the space; I could try to explain what I think the most favorable interpretation was, but then I'd feel obligated to first try to explain what I think the least favorable interpretation was, and at that point this would be 5 times the length and mostly me arguing with myself to try to somehow persuade you, and this sentence is already too long. Mostly, I think this type of clash is inevitable in a truly intellectually diverse setting, and I don't think quiet 1-month bans are going to be a good way to handle it. To half-joke, maybe there should be a sign like, "on this blog we take people's ethical systems seriously"? I dunno.
Scott, Substack thought this comment was too long, so I broke it in half. This is PART 1 OF 2.
I think you should greatly reduce gunflint’s one-month sentence. I think just giving him a warning is about the right response. Here are my reasons for obecting to your one-month ban for his post — in fact not just objecting, but being kind of stunned by it.
*It’s not bad enough*.
Let’s apply the rule of 2 out of 3. Is Gunflint’s post true? Well, Gunflint does’t express his reaction in a direct statement that can be supported as true or attacked as false, but I think most readers would grasp the idea he was expressing indirectly: OP’s desire not to have his kidney save a carnist sounds precious and entitled: He presents himself as so big-hearted that he is determined to reduce the suffering not not only of people, but of animals too. But there’s something very self-focused and privileged about his determination to fine-tune his life to the point that he gets to do *precisely* the form of giving that will make him feel pure and perfect. (Gunflint’s mention of single mothers is of a piece with this point: He’s contrasting OP’s expansive view of his life options to those of someone struggling to make it in the real world.) Seems like if Gunflint had laid out his thoughts straightforwardly, as I just did, it would be a reasonable argument against OP’s take on things. Was this argument necessary? Well, if Gunflint had put his thoughts as a direct statement, he certainly would have been advancing the argument about the validity of kidney donation as altruism. Was it kind? Seems kind *enough* anyway. He’s saying indirectly that OP’s idea is very silly, but his way of saying it is a relatively gentleway of getting that across. And in fact things like calling someone’s argument silly happen on here all the time — people clearly don’t see them as a banable level of unkindness.
Gunflint’s comment wasn’t even the worst response to OP. I responded by asking whether there was a case to be made for killing carnists. I think my comment has a passong score because it’s a reductio ad absurdum argument against OP’s view. But it was probably pretty clear to people that it was also a way of making fun of OP’s view. Then Deiseach made fun of OP, in a fairly harsh personal attack: “But spare *me* the Sarah Bernhardt performance over "oooh, by anonymously helping a fellow human-being I may be contributing to the torture of conscious beings". Then Quiop slightly advanced my argument by commenting that since most people are carnists the expected utility of killing any random person is high. Quiop then proceeded tp very overtly make fun of effective altruism: “I think the only way of getting around this is to make a longtermist argument that preserving humans for now is currently the only plausible strategy for making progress towards the ultimate goal of establishing luxury gay space shrimp communism throughout our entire light cone.” I was quite entertained by this sentence, but from the point of view of 2 out of 3 of true, necessary and kind I’d say it’s the least acceptable comment on the thread. Calling the EA vision “luxury gay space shrimp communism” is a way worse way of saying EA is absurd than Gunflint’s remarks about OP leading a privileged life compared to single mothers etc.
*There’s something wrong and dehumanizing about not taking what you know about someone into account when making judgments.*
Gunflint has been posting on ACX the whole 2 years I’ve been here, and I don’t know how long before that. He’s more consistently kind and fair-minded than anyone I can think of, except I guess Nancy Leibowitz. Here’s some recent evidence of that: He made no comment at all about the Palestinian-Israeli situation til a week or 2 after discussion of it started on here, then posted that be felt he should not say express any views without first spending a couple months educating himself about the area and its history. I think the likeliest explanation of Gunflint’s posting the comment he did, which if taken purely at face value is a bunch of unsupported negative insinuations about OP, is that he assumed people would know what he meant — and/or maybe he was tired or preoccupied and forgot for the moment that if you say on here that someone’s whole take on an issue is silly, you’re supposed to back your view up with evidence and arguments.
"He presents himself as so big-hearted that he is determined to reduce the suffering not not only of people, but of animals too. But there’s something very self-focused and privileged about his determination to fine-tune his life to the point that he gets to do *precisely* the form of giving that will make him feel pure and perfect."
Thanks for writing this, now I understand better why I am receiving so much animosity on this comment.
Of course, this is pure interpretation of my motivations and it has no place in a serious rational debate. I am quite disappointed by the level of argumentation in these comments to be honest, a lot of post-hoc rationalisation driven by immediate emotions. A lot of strawmaning, putting words in my mouths... I would have expected more rationality here, but I guess veganism brings out the worst reactions even in the best communities...
I do think it's likely that many people had the same take on it I did, and that's why you got anger back.. I do recognize that that take may not have been accurate. But here's something to think about having to do with the issue of privilege and the attempt to be pure. If you live in the US or another wealthy country, even if you live very modestly, you are the beneficiary of many cruel acts to people and animals even if you do not eat meat or wear leather. Parts of your electronics were probably made by underage workers in poor countries. Preparing data for AI training involves tagging images with terms like "fruit," "yellow," "food," "realistic photo," etc. There are very precise, intricate rules for labelling a given set. This fairly difficult and insanely tedious work is mostly farmed out to Africans. To even qualify for the job you have to speak good English and have a college degree. These workers get paid $8 and hour. It is very isolating work because people with the job are not allowed to tell anyone the details of what the are doing or let them see what you are doing. Every time you use AI, or a web site or service that uses it, you are benefitting from the labor of these people. And so on. Unless you live in a hut and eat only nuts and berries from the forest, you are benefitting from exploitation of others. I'm a vegetarian myself, but have no illusions that no animal was harmed to make possible various things in my life. You might think about the possibility that it makes more sense to put your efforts and smarts to work helping sentient beings, rather than trying to free yourself of any responsibilty for their exploitation.
Say someone comes to me and points out:
"You are doing action A. It is causing harm, you should stop doing it like I have."
What I do:
- figure out if that is the case, and balance potential trade-offs
- if that is the case, try to fix it. Ideally not doing action A, if that is feasible at all, if not feasible work towards or find alternate ways to stop the harm
What I will not do is come back at this person and tell them: "There are all these ways you are doing harm yourself. You have only stopped doing action A to feel good about yourself. Stopping doing action A is pointless" and discard the issue.
Not only is it bad epistemology, but it is also literally harmful. This is a very serious point: By using this rhetoric you are attacking people trying to do the right thing, discouraging them, and actually causing harm.
Also, "You might think about the possibility that it makes more sense to put your efforts and smarts to work helping sentient beings, rather than trying to free yourself of any responsibilty for their exploitation."
Why are you assuming that I am not working to help sentient beings?
What makes you think that I am trying to free myself of responsibility?
These are uncharitable assumptions on me and my motives, but I don't see what warrants them in what I have written so far.
BTW, kudos for being very nice and civilized in your argumentation, much appreciated :)
PART 2 OF 2
So, Scott, I know you don’t read all the comments, but clearly you read some of them, and it seems to me that by now you must have developed a general sense of what kind of poster Gunflint is. And that kind of goes both ways. I’m pretty sure that he and the other frequent long-time posters have the feeling that you have seen enough of their comments to have a sense of their interests and how they think. Of course your picture of us would not be as vivid as our picture of your interests and how you think, which is based on reading lots of your posts — but it would be the same sort of thing, just in miniature. I have, for instance, the impression that if one of the regulars died you would have a little something to say about them and what you’ll miss. If in fact you don’t — if Gunflint is just a familiar name for you with no information about him attached to it — that’s just not good. We are all sadly misled about you and your forum. I think one thing the regulars like about ACX is a feeling of being known —by other posters, but also by you. People go through a lot of life in settings where they are not known. I hate my rare visits to my internist because her nurse always tries to help me down off the examining table, I assume because of my gray hair etc. I rode my bicycle 3 miles to the appointment, for god’s sake! It’s unpleasant to be Grayhead Stiffjoint to these people, when I am in fact fairly nimble and strong. Regulars here feel known. And most of them care about you. When you dropped out of sight people started to worry out loud about what was up, and speculate uneasily about bad things that might had happened to you. Some thought maybe you’d become a father, and there was talk of giving a gift for the baby. Then you told us about your kidney donation, and there was a tremendous emotional reaction (not all of it positive).
We’re not your friends, exactly, but there’s some kind of personal connection here — surely you sense that, and the fact that we sense it too — and given that connection is it’s just uncivilized not to take into account what you know when responding to posts that don’t make the grade. I understand that there is no simple way to combine use of a simple rule with taking context into account, but I really think kindness and common sense oblige you to. Let’s say you had a huge lawn with nice big shade trees, and strangers often treated your lawn like a park and picnicked there. Maybe you’d have a simple rule about what kind of people you allowed to do that. Maybe if they were quiet you’d ignore them, but if they were rowdy you’d come outside and insist that they leave. Fine. But now say you’re the head of a company and you invite your employees to a company picnic on your grounds. And most of the people who show up are the 100 or so full-time employees whom you know, not the temps and contractors. So if one of the full time employees gets loud and rowdy, you might ask him to quiet down, but you wouldn’t tell him to just get off your lawn and not come back for a month. First of all, you’d probably understand his rowdiness — he always gets that way after a few beers, but he’s a cheerful drunk and never provokes fights. And second, it’s harsh and uncivilized to kick an acquaintance out of your yard. They would be shocked and deeply hurt (as I’m guessing Gunflint is).
So, Scott, I really think that the civilized way to respond to transgressions by a commenter you know, and know to be consistently kind and reasonable, is to take their history into account when you respond to a one-off bad comment of theirs. If you want to be algorithmic about it, you could mentally award the person some credits for a long history of courteous, clear posts that advance the argument, and then throw in some debits proportional to the badness of their problematic post. If they still have a positive balance, you can just let it pass — or send them an email saying “come on, you’re better than that,” or “this post really does not meet community standards. Please don’t post this sort of thing.”
*What’s there to lose? You’re not consistent in applying your algorithm anyway.*
I’m pretty sure you’re not at all consistent in your bans anyhow. A couple months ago I posted a long angry riff about AI honchos’ obliviousness to the humanities. As I remember the thing, it contained no evidence at all for that view — just a mocking portrait of these people as I saw them. You have me half a ban. Carl Pham, very irritated because a newby he’s arguing tells him he has poor reading comprehension, tells newby they’re an excellent example of the Dunning -Kruger effect, and you ban each of them for a week. Meanwhile, I have I have reported about 4 posts since the last time you updated your bans, and everything I reported is still up. I only report posts that, in addition to making unsupported claims, are exceptionally rude or cruel — For example, this bit of commentary about the Israel-Palestine commentary: “What happened to all the dancing in the streets and the outpouring of joy over the greatness of god that we saw on the 7th? Funny, haven't seen too much of that recently! Hahahaha.” That piece of crap is still sitting on the thread, along with a few similar ones on earlier threads. Meanwhile, Gunflint is banned for a month.
And I think, though I’m not quite sure, there are some consistent biases in your bans. You’re more likely to ban a poster for a comment early in a thread, maybe because you’re more likely to read the early parts (though in fact a lot of the really bad shit gets said way later, after things have heated up). And you’re more likely to ban early responders to posts of yours who make negative comments. (They generally are negative comments that do not meet the 2/3 rule, but they’re often not awful comments.). Examples: Your ban of the person who posted the first response to your review of Don”t Look Up. As I recall, it was in fact a harsh and negative comment, but the poster did make some effort to justify his view — maybe saying something like, “don’t you know science doesn’t support any of that?” You banned JDK who commented on one of your posts that it was way too long and wordy. You banned Gunflint for a technically substandard comment criticizing EA in the comments on your kidney donation post.
1. Where did you read any mention of EA?
2. This is the most important point, I kindly (honestly, no sarcasm, I wish you the best man, even if it's hard to get this feeling across in a response like this) encourage you to reflect on it. "Charmed life". Do you look at reality on its own terms? Are you aware of the amount of suffering that exists out there and where it comes from? Or do you prefer to ignore most of it so that life can feel more "charmed"?
3. What do you know about my situation and the problems I am dealing with?
4. Do you know that I am not "a single mother trying to come up with this month's rent"? Or someone in an "equivalent" situation in your eyes?
So is there a case for killing carnists? Seems that would be a highly effective way to reduce animal suffering. Of course the families of the murdered carnist would suffer emotionally, but maybe the total amount of family suffering is less than the total suffering of the animals the person would have eaten if they’d lived.
...and since most people are carnists, the expected utility of murder is positive, even if you don't know whether the person is a carnist or not.
I don't think this is the most persuasive argument for human eliminationism, but as far as I can tell it is a valid one.
(I think the only way of getting around this is to make a longtermist argument that preserving humans for now is currently the only plausible strategy for making progress towards the ultimate goal of establishing luxury gay space shrimp communism throughout our entire light cone.)
I love you last sentence. If our species does colonize other worlds I think what you're really going to get is human beings fighting and fucking on every available level surface. Like always
Ah, but if you then harvest the organs of the filthy blood mouth carnist, you could save at least five vegans! It pays for itself!
>> The thing is, I care about animal suffering almost as much as I care about human suffering. And I fear that by giving a kidney to a random person, the chances that they are a carnist are overwhelming. As a pure counterfactual, my action of saving this person will then cause immense suffering, potentially 10 to 20 years of daily contribution to the torture of conscious beings.
Do you extend this principle beyond kidney donation? Thinking of things like:
Is the trolley problem actually simple for you, since all the people tied to the tracks are probably carnists so there’s less net suffering in the world if more of them die?
If you saw a child drowning, or man hit by a car, or found a co-worker collapsed in the office, and you’re the only person there, do you not intervene or dial 911 because “chances they are a carnist are overwhelming?”
Is it your preference that no one intervene to put a stop to or take refugees from crises like the Russian invasion of Ukraine, or earthquakes in Turkey or Haiti, since most of the people dying there likely eat meat anyway? Is FEMA assistance technically a bad thing that actually increases suffering?
(Godwin Alert) Put another way, was it technically a good thing that America turned the boats around and sent Jewish refugees back to Nazi Germany, since most of the people on them probably ate meat? Did that decision operate, in the grand scheme of things, to reduce suffering? If you were in FDR's cabinet, would you be telling him to consider the lives of the helpless animals those refugees and their descendants would surely eat if they were saved?
These things seem to flow from your argument, but if they represent your actual thinking, they seem more parts savage than moral. To an outside observer it looks like window-dressing around a core principle of “I’m not saying I’d kill people personally, but it’s actually good when they die."
But you also say that you admire Scott’s decision to donate a kidney, and describe his act as one of selfless courage, so it seems more likely that there’s some kind of disconnect at work here.
I thought about this recently and I think the obvious answer is to just donate 10% of the $50k to some effective animal charity. I'm not smart enough to do the math, but there's no way it takes more than $50k to offset 15 years, and I personally doubt non-animal meat is over 20 years away.
As someone thinking about donating a kidney, I have two concerns with the cost benefit analysis here. Firstly, it seems to me that the expected utility of donating a kidney today is only positive conditional on it being the case that:
(a) You do not have the opportunity to just save some other person’s life by letting them use your kidney after you die.
And it seems that (a) will only hold if: (1) the organ shortage is solved within your lifetime, and/or (2) your kidney will not be in useable condition after your death. I think an analysis of the probability of (2) would be helpful here.
The other problem: people who actually do donate their kidney to a stranger are clearly a very weird subpopulation, differing in all kinds of ways from those who could be allowed to do so but don’t. So these possible but unwilling doners may not be a good control group for examining the effects of kidney donation on actual doners.
Only 3 in 1000 organ donors die in a way that their organs are actually usable, which makes this a rounding error to the cost benefit analysis.
Thanks for this! Do you have any source in particular you'd reccomend regarding this point?
Scott, do you think in retrospect it would have been preferable to just lie about the childhood OCD? Or is this a feasible path for other people with long-ago resolved mental illnesses? Especially if your childhood was before the era of electronic medical records, it seems they wouldn't really know about any past mental illness unless you told them (or unless it was obvious enough that a psych would notice it in the interview, in which case it's not really resolved.)
Counting this as one more piece of evidence for my general rule of being very careful what to tell doctors. They are not on your side. They are on the establishment's side.
Would you encourage your own kids to donate their kidney? At what age?
Thanks for donating. True gift to the recipient.
After reading the title I was afraid Scott lost his kidney. Turns out Scott lost his kidney... voluntarily.
so its illegal to sell my kidney.
But could I demand a 100k charity donation from the receiver?
Regardless of your reasons for donating a kidney, thank you from a myeloma survivor with kidney failure who does not qualify for a kidney transplant, because I have not had a consistent two-year remission in 8-1/2 years. Thank you for working with UCSF, to whom I donate money for the BioKidney project. If and when the BioKidney becomes widely available, the dialysis industry will be devastated.
Can I plug the stem cell registry?
- Charity called Anthony Nolan, you just spit in a vial and send it by post
- If you're a match for someone who needs a transplant, then you're contacted
- You then get asked if you are okay with actually going through with it
- You get some injections for a couple of days, then one or two days in hospital with a canula in your wrist taking out your blood, whirling it around to centrifuge out the stem cells, then putting it back
- That's it!
I got invited just over 4 years ago. Mine was slightly more complicated because I have low blood pressure so they ended up fitting a central venous line, which is more invasive than a normal cannula. Also, I freaked out (not a fan of x-rays or needles), and so probably some of the tiredness afterwards was from that. Then I refused to give in to the tiredness and did two gigs the next week, restarted lectures, and did my coursework presentation, which meant it took me a few months to actually recover. Oh also, I got low on Calcium which made me a bit confused.
Like Scott, I meant to do a "this was totally fine" post afterwards, and then ended up just crying at anyone who spoke to me from exhaustion. This is partly because university didn't really do support for being ill, you just had to make up the time. But, if I'd done the op with a job, I'd have just taken a few days of sick leave and it would have been great. So sign up to the register if you want an easier moral high than a kidney (with lower chance of selection) :) - you also get a t-shirt or a mug!
Does this involve having your expenses reimbursed like the kidney donation?
Hi Kayla! Speaking as someone who used to work for Anthony Nolan, yes! You get your expenses reimbursed, including any travels if necessary and a hotel for the night before and after, for you and a companion. They also cover for loss of earning so don’t have to necessary take holiday leave from your work. It’s a very easy process! :)
If some rando in New York starts pouring out long and incredibly well-written essays filled with venom toward political correctness, moving website elements, and the New York Times, we're really going to have to reevaluate a lot of things.
So selling your organs is just generally acceptable by the community? I mean, I personally don't have a strong opinion on the matter, but just checking that's what is being proposed.
I've long been meaning to write a post about my own kidney donor screening process; if this article doesn't give me the push, nothing will.
I planned to donate my left kidney to my father, who had ESRD. As you did, I attempted a cost-benefit analysis and ended up concluding the medical risks to me were negligible. Embarrassingly, the biggest quality-of-life factor on my end was the prospect of changing from a no-significant-medical-events person to a one-significant-event person. Once you donate, doctors will expect you to report for checkups once a year and watch your salt consumption, instead of swanning through life without a care as donation-eligible people can otherwise do.
On my dad's end, the analysis was more complicated: I compared the ~5 quality-adjusted years he could expect with dialysis against the ~10 quality-adjusted years he could expect after a transplant. How does going through hemodialysis 2-3x a week compare with having major surgery (riskier for the recipient than the donor) and then taking immunosuppressants for the rest of one's life? Before COVID it would have been a no-brainer. Now... transplants are still preferable but not overwhelmingly so.
For the EA-inclined, there is a financial aspect as well. Dialysis is EXPENSIVE. If you live in a country with socialized healthcare, I expect you can already donate a kidney out of financial self-interest, NOTA or not.
In the end, I flunked out during psychological screening just as you did. The social worker asked me how I was doing and I told her (like an idiot) that being under lockdown made me feel isolated, and seeing my dad suffer from kidney disease made me feel sad. She then recommended to the doctor that I _not_ donate a kidney to my dad until I got a handle on my dad-sadness, lest I make an irrational decision. Let this be another takeaway: HOSPITAL SOCIAL WORKERS EXIST TO TICK BOXES! DO NOT TREAT THEM LIKE HUMAN BEINGS!
I planned to wait a few months and re-apply, but my dad died of a dialysis mishap a few weeks later. Whether I had passed the sanity test or not would have made no difference.
A way less drastic step that everyone can probably take right now is to figure out how to tell the system that you're cool being an organ donor in the event of an untimely death. For Australia, this is super easy - go to myGov > Medicare and there's an organ donation box you can tick. I can't speak for anywhere else.
So calling all Australians: go to the Medicare page and tick the box saying that you consent to being a post mortem organ donor, if you're not quite ready to part with a kidney yet. That way, if you get hit by a bus tomorrow and never get around to it, your kidney will still help (and hilariously I think it's actually significantly lower effort than getting screened for kidney donation while alive)
Hi, I received a kidney from my father in Februaey this year, and i feel terrible for how it left my father feeling. My drs didnt scan him properly and found out on the operating table that he had three arteries connected to his right kidney. . Now we are both sitting below 50 percent wuen previously my healthy father had a function of 85%. Drs told us it wouldnt be a problem. Now they tell us his kidney was probably too old when they could have mentioned that earlier. Im still fighting off rejection and have a dialysis tube in my heart. Peo0le love to say how easy it is to donate and receive transplant, but its really not. It is a big deal.
https://www.pushkin.fm/podcasts/playing-god/why-cant-i-buy-a-kidney
why does having an income change the morality?
I donated my kidney, and found the staff at UCHealth to be awesome. If you're in the Colorado area I would recommend going through them. When I went through the intake, they did not require a CT unless some of the other tests gave them a reason, but that may have changed or may be different depending on your surgeon. I am happy to talk with anyone who's interested and has questions. I donated three years ago, and have had exactly 0 issues since my recovery from surgery, which took about a week for the acute stuff and about 2-3 months to get back to my pre-surgery level of activity.
The Dylan Matthews article was also instrumental in my choice, and I 100% agree with the quote:
> As I’m no doubt the first person to notice, being an adult is hard. You are consistently faced with choices — about your career, about your friendships, about your romantic life, about your family — that have deep moral consequences, and even when you try the best you can, you’re going to get a lot of those choices wrong. And you more often than not won’t know if you got them wrong or right. Maybe you should’ve picked another job, where you could do more good. Maybe you should’ve gone to grad school. Maybe you shouldn’t have moved to a new city. So I was selfishly, deeply gratified to have made at least one choice in my life that I know beyond a shadow of a doubt was the right one.
I feel like donating has raised my floor of how good my life is; no matter what else happens, I did a really good thing that I'm proud of.
BTW, at my very first real "job", circa 1994-95, like my first month, I TOTALLY fell for the "urban legend where you have one-night-stand with hot stranger and wake up in bathtub full of ice with kidney missing" chain/scam e-mail. I forwarded it to the entire company as a DIRE warning.
Boy did I feel stupid.
So, seeing it referenced here, fills me with warm and complex shame, and deep affection for my younger self. I feel closer to you all.
B
Performative nonsense.
You had this operation so that you could possess an experience you feel unabashedly good about.
You have failed.
If you had children, you'd never do this.
Actually, a practical question for Scott, since he got around a loophole. Some time ago I tried to sign up for a bone marrow donor list. (It sounded like an obviously right thing to do, and, besides, people seemed to think I would be a valuable addition to a special list, simply because I declared (truthfully) that my mitochondrial DNA is almost certainly Amerindian - that, of course, is massively non-special in my place of origin.) Unfortunately, my answers to the questionnaire made me non-eligible - since I had had melanoma in situ a few years back, I had to declare that I had had once had cancer. Question - what is right and what is possible to do in this situation?
Possibilities:
- Tell a technical lie by marking "no" on "has had cancer" rather than checking "yes" and scribbling "but it was melanoma in situ more than two decades ago"
- Just try again while being truthful, it's been more than two decades by now (the donor thing happened well over ten years ago)
- I should have just tried to sign up through other channels
I can see how the general rule is completely sensible here, but I hope we can also see why it shouldn't apply here (it's essentially a certainty that the cancer cells never made it out of the mole; the probability of the contrary is microscopic compared to everything that could go wrong with a bone-marrow transplant).
Bonus question: do things like which subgroup the straight maternal line goes back to actually matter for compatibility purposes?
I'm surprised others haven't brought up my reason for not donating. That is, why should I be the only one in the chain without compensation? Or, why don't the surgeons involved donate their time, why doesn't the hospital donate its facilities, why don't pharmaceutical companies donate their drugs, etc.?
Amen. Let's compensate donors. https://www.modifynota.org/