In this guest post series, I’ll write about ethical career choice. Within law school, students often face a dilemma about which field to go into. On one hand, one could go into an ‘ethical’ field, such as a district attorney or public defense job — and, for the readers of this blog, I guess that health law and academia are also salient options. On the other hand, one could go into corporate law, where there are more jobs, better pay, and less bureaucracy, but little direct positive impact. For many people, this can seem like a dilemma between doing what’s best for yourself, and what’s best for the world.
Category: Philosophy
Transplant Tourism: Hard Questions Posed by the International and Illicit Market for Kidneys, New Article I Wrote
[Cross-Posted at Prawfsblawg]
The Journal of Law, Medicine, and Ethics has just published an article by me on transplant tourism, that discusses the burgeoning international market for buying and selling kidneys. I review the existing data from Pakistan, Bangladesh, and India, which is pretty deplorable. As I show the vast majority of these sellers are poor and using the money (which is a significnat sum in terms of what they earn, even though in the end only 2/3 is paid) to try to buy themselves out of bonded labor, pay off familial debts, or try to mount a dowry. Many are misinformed or decieved about the health consequences for them and the needs of the person who will receive their kidney. Once they have agreed to sell they are often pressured not to renege. They are often released too soon post-transplant compared to what is optimal for a transplant, and their self-reported health post-transplant is worse. Many experience significant social stigma as a “kidney man” (or woman)and the 20-inch scar (the more expensive way of doing the procedure would reduce the scar size) marks them for life and makes it difficult for them to marry. Most express significant regret and would advise others not to undertake the operation.
Despite these grave facts, as I argue in the paper (and in greater depth for many of these arguments in the chapter on transplant tourism in my new book on medical tourism under contract at Oxford University Press), many of the traditional justifications from the anti-commodification literature — arguments relating to corruption, crowding out, coercion, and exploitation — do not make a convincing case in favor of criminalization. If a ban is justified, I argue the strongest arguments are actually about defects in consent and justified paternalism, on the assumption that criminal prohibition is a second best regulation in the face of the impossibility of a more thoroughly regulated market.
I then examine what means might be used to try to crack down on the market if we concluded we should. I evaluate possibilities including extraterritorial criminalization, professional self-regulation, home country insurance reimbursement reform, international criminal law, and of course better organ retrieval in the patient’s home country.
I will keep writing on this topic, including for my new book, so even though this paper is done feel free to email me your thoughts.
Happy Public Health Week: “We’re Good Enough, We’re Smart Enough, and Doggone It, People Like Us”
By Scott Burris
We may be living in a golden age of group-think. A weekly reminder is poor Paul Krugman railing against the apparently universal belief in America and Europe that we’ve got to cut budgets right now or disaster will strike. He calls this a Zombie idea, a false claim that has been falsified with plenty of stakes in the heart, silver bullets and blows to the head, but will not stay in the grave.
Closer to home for us in public health is the claim that Americans don’t like government rules regulating their behavior and meddling with their preferences. Cass Sunstein and Richard Thaler have delivered some solid blows to the idea that paternalism typically messes with solid preferences. As we celebrate Public Health Week, I want to highlight two recent papers that show that Americans, like the children in Mary Poppins, actually like their nannies, who do some pretty great things.
Public Health Law Research has recently posted the manuscript of a paper that Evan Anderson and I have prepared for the Annual Review of Law and Social Science. The paper describes the dramatic rise of law as a tool of public health since the 1960s in five major domains: traffic safety, gun violence, tobacco use, reproductive health and obesity. These topical stories illustrate both law’s effectiveness and limitations as a public health tool. They also establish its popularity by the most apt of metrics – the willingness of legislators to enact it. The one picture worth a thousand words, below, depicts the rapid adoption of a variety of interventions by state legislatures. (By the way, the five examples also show that public health law research can and does influence the development and refinement of legal interventions over time.)
Feb 28: Ruth Grant speaking to the HMS Division of Medical Ethics
Please join the HMS Division of Medical Ethics and Program in Ethics and Health for…
“Strings Attached: Untangling the Ethics of Incentives”
Professor of Political Science and Philosophy, Duke University
Thursday, February 28, 2013
12:00 – 1:15 PM
HMS Division of Medical Ethics
1st Floor Conference Room
641 Huntington Avenue, Boston
A light lunch will be provided. RSVP required to DME@hms.harvard.edu.
Ruth Grant is a Professor of Political Science at Duke University and a Senior Fellow at the Kenan Institute for Ethics, specializing in political theory and political ethics. Her most recent book, Strings Attached: Untangling the Ethics of Incentives, examines moral concerns raised by the pervasive use of incentives to shape behavior. Her seminar talk will propose an ethical framework for thinking about the promises and limits of incentives, including the use of incentives in public health.
Save The Date: Making Science Work with Sir Paul M. Nurse
With Panelists:
- Eric Lander, Broad Institute and Biology, MIT
- Lisa Randall, Physics, Harvard University
- Charles Rosenberg, History of Science, Harvard University
Moderated by: Sheila Jasanoff, Pforzheimer Professor of Science and Technology Studies, Harvard Kennedy School
Wednesday, February 6
5:00 – 7:00 pm
Pfizer Lecture Hall
Mallinckrodt Chemistry Lab B23
12 Oxford Street, Harvard University
Cambridge, MA
Making science work for human benefit requires making good decisions about what scientific research should be supported and giving good scientific advice for public policy. The term public good is meant in the widest possible sense, covering the contributions science makes to our culture and also the applications of science that benefit society: improving our health and quality of life, securing sustainability and protection of the environment, and driving innovation to support our economy.
Sir Paul Nurse is a British geneticist and cell biologist. He became the 60th President of The Royal Society in December 2010. As a geneticist, he studied the mechanisms which control the division and shape of cells. In 2001, he was awarded the Nobel Prize for Physiology or Medicine for the discovery of the key protein regulators of the cell cycle. He has been Professor of Microbiology at the University of Oxford, CEO of the Imperial Cancer Research Fund and Cancer Research UK, and President of The Rockefeller University, New York. Since 2011, he has been Director and CEO of the Francis Crick Institute in London. Nurse has received the Royal Society’s Copley Medal (2005), the French Legion d’Honneur (2002), and is a Foreign Honorary Member of the American Academy of Arts and Sciences (2006). He was knighted in 1999 for services in cancer research and cell biology.
This event is organized by the Program on Science, Technology, and Society, at the Harvard Kennedy School and co-sponsored by the School of Engineering and Applied Sciences, the Graduate School of Design, and the Harvard University Center for the Environment. For more information on Science, Technology, and Society events at Harvard University, please visit: www.ksg.harvard.edu/sts/. This lecture and discussion is free and open to the public.
Contact: Lisa Matthews, lisa_matthews@harvard.edu, 617-495-8883
The Society for Philosophy and Disability Is Official
By Nir Eyal
With an approved constitution, elected officials and now, recognition from all three divisions of the American Philosophical Association (APA), a new society is finally official. The Society for Philosophy and Disability, or SPD, will hold its first two sessions at the February 2013 Central APA meeting in New Orleans.
SPD is a non-profit educational organization dedicated to furthering research and teaching on philosophical issues related to disability and to promoting inclusiveness and support for people with disabilities in philosophical education and in the profession of philosophy. SPD aims to provide a forum for philosophical discussion of disability by arranging meetings, maintaining an online presence, and organizing academic projects.
Adam Cureton, President of the Society, invites everyone to join SPD, which they can do on the Society website. You are also welcome to invite colleagues or students who are interested in philosophy and disability to join us.
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