Instigator / Pro
4
1674
rating
53
debates
67.92%
won
Topic

THBT Regulated Markets for Human Organs Should be Legal in UHC

Status
Finished

All stages have been completed. The voting points distribution and the result are presented below.

Arguments points
0
3
Sources points
2
2
Spelling and grammar points
1
1
Conduct points
1
1

With 1 vote and 3 points ahead, the winner is ...

whiteflame
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Politics
Time for argument
Three days
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10,000
Contender / Con
7
1670
rating
20
debates
87.5%
won
Description
~ 774 / 5,000

With a lot of interesting plans for the pro side, I’m curious if it’s enough to overcome the con case. Standard definitions from Merriam Webster apply to this topic. Burden of proof is shared. No new arguments in the final round.

The regulated market in economics is oversaw by the government. They need to make laws and restrictions about how to sell, what to sell, so on and so forth, in order to allow people to sell safely.

Organ: A relatively independent part of the body that carries out one or more special functions. Examples of organs include the eyes, ears, heart, lungs, and liver. (https://www.medicinenet.com/organ/definition.htm)

UHC: Universal Healthcare Countries [https://www.health.ny.gov/regulations/hcra/univ_hlth_care.htm]. This doesn't include Cuba.

Round 1
Pro
Thanks, Whiteflame.

I. Economic Net Benefit 

In layman's terms, give them your help, save their lives; get a little help, save yours too. My framework here is based upon a study by three experts. The layout of the payment vs saved money is very easy to see. Even at a $45,000 compensation for the kidney donor, this is nothing compared to the $1.45 million saved from the expensive procedures. Not only so, receiving the transplant will greatly help the health, with an expected 10-year increase in life years, compared to only a 7-year increase. While three years [plus some more small math] seems insignificant, the authors note that "valuing each of these years at the consensus estimate of $200 000 produces a lifetime welfare gain of $937,000 per kidney recipient ". Even if we lower the quality of life by half (100,000$/year), the net welfare would still raise the net benefit above $1 million (see "key innovations" part of study). So here we see already the economic benefits.

On the bigger picture, the taxpayers save up to almost $50 billion. They had to expend the money for the dialysis and kidney transplants. An extended half-life of the kidney also leads to a second transplant, solidifying the organ market's health benefits. Under the status quo, we are unable to ensure health ideals in the long term. If this wasn't convincing enough, they released a second paper. Even with pessimistic estimates that only the poor donate, and only half the poor would be able to access such services, the net benefit would still result in $7 billion nationwide, 7 times the current benefits. Even if con would dismiss on its seeming theoretical ground, the empirical evidence is already here. A study from Chile notes that "We find that monetary incentives of US$12,000 save US$38,000 to health care system per donor and up to US$169,871 when we consider the gains in quality of life of receiving an organ." Combining theoretical study and real statistics together, it seems impossible to dismiss the power of the net benefit analysis.

The impacts other than the economy are simply logical to think about. When there is a shortage of organs, the black market would likely be able to sell off and exploit the poor worse off. But with legal status put into restriction, people would think twice before selling their organs for a shoddy few thousand dollars. The government-sponsored selling would encourage the organ shortage to be solved. As more organs are delivered, the reduction from $75,000 (the recommendation of the second paper re-accounting for medical costs) to $45,000 (the base price of Kidney from the first paper) will still help the poor person in the long run, while alleviating government costs. So the balance out act works out very nicely, and we kill two birds with one stone. 

II. Iran: an Example Worth Following

Though Iran is not a UHC, it is the only country that has implemented my desired plan for the market, and therefore worth a look into seeing the effects. From a letter written from a medical scholar, Bahar notes that the Iran model is a good example of why pro's ideals will succeed on a practical level. Firstly, they establish the problem even in the most developed countries: " In the United States there are currently more than 100.000 patients waiting for kidney or kidney-pancreas. However, the supply of kidneys that stagnated around 16.000 to 17.000 per year...  while only 20% of the half-million dialysis patients in the USA make it to the transplant waitlist, of them 5,000 die each year waiting". The impact of lost lives is very clear. If we can even net save one life, it's a pro vote. Nothing could be more important than a person's life except for perhaps freedom, and my plan precisely grants extra freedom rather than restricting it. It's a win-win situation.

Now back to Iran. The writer notes that many guidelines are put into place, which I will advocate for my policy until con knocks them down. Most importantly, the results of applying to Iran is resolving the organ donation shortage. Bahar argues that "unlike anywhere else in the world, everyone who medically qualifies for a transplant in Iran can begin the process for getting one, and in some regions of the country there is even a waiting list for people who want to donate." Even with common arguments about coercion, this is insignificant because the alternatives may be to murder and steal from others -- far worse than sacrificing your health. The government bought system also reduces the possibility of manipulating the other. With the trusted authority put in place, I see no problems for the UHC's. 

If a letter's claims are not enough, one needs to look no further than PubMed. The trusted journal states the same conclusion clear and well. "In 1988, a compensated and regulated living-unrelated donor renal transplant program was adopted in Iran. As a result, the number of renal transplants performed substantially increased such that in 1999, the renal transplant waiting list was eliminated... Currently, Iran has no renal transplant waiting lists, and >50% of patients with ESRD in the country are living with a functioning graft." The impacts are then incredibly clear. We save all the 5,000 lives that would have died each year. There will no more waiting list within the countries. There will be less exploitation in the black market, rather than more. 

Even if con somehow knocks this down, there'll still be the lingering fact that the legalization of the organ market would encourage a well-structured system for procuring organs. It's well known that in developing countries, the facilities are poorly regulated and causing problems for the transference of organs. It would be near impossible to shut down all these. In contrast, by ironically encouraging the buildings, standards are set and the system for transference of organs would work out in the end. 

III. Does Not Devalue Human Life

It may be a bit early for rebuttal, but nearly every single contender for markets always makes this argument. So it's good to argue against this idea. Many say that human life is devalued in a unique aspect because the organ market encourages you to sacrifice your life. This seems reasonable on the surface, because non-essential organs have a negligible impact on both receiver and sender, thus being difficult to support under the Pro case, besides the freedom argument. However, the difference between donation and compensation is a thin line. Kantian ethics argues that we treat the organ as a "thing" -- which you cannot do to human dignity. But donation also treats it as some means to an end, if only to preserve the others' life. The compensation also helps you live your own life (as presented above) and therefore can be justified based on Kant's ideas. He wants us to protect our bodies at nearly any cost, and he would agree that amputating a limb to survive is acceptable so long as you do not lose your honor through the process. The preservation values comes down to a standstill, because the impact of the trade still allows you to further your own life. Either we say compensation should not at all be accepted -- a horrible position, I'm sure -- or we accept both, for the intention of helping the donor live a bit more, and still help the recipient.

Regularly through other work, the poor are allowed to sacrifice their bodies willy-nilly -- clocking in overtime, working in hazardous construction sites, carrying hefty weights that may damage your knees in the long run... In essence, there's too much similarity to other work that makes the organ market potentially "extra dangerous" or unnecessary. Either Con has a way to solve *all* health issues within jobs, thus potentially making the market a unique danger, or he must swallow the fact that we have to allow some measure of harm of people to themselves.

Conclusion:
  • Organ market system may earn up to billions of dollars in terms of net benefit
  • Organ market will save lives, and solve problem of organ shortage
  • The opponents of Organ market do not have a logical ethics argument to stand upon, while Pro has freedom for the people

Con
Thank you to Undefeatable. I look forward to a fruitful debate.
 
Framework
 
The value that should underpin this debate is distributive justice. The principle is that resources should be allocated justly, with the rewards and costs equitably distributed across all groups within a given population. If utility comes at substantial cost to given subset of society, then the bias of those effects must be addressed, as they create, exacerbate, and entrench inequities. What separates this market from others is that what the sellers are hawking irreplaceable pieces of themselves. Any lack of distributive justice in this market creates a permanent disparity. This loss stands as a permanent symbol of their status that no other gains can erase, justified by a monetary windfall and by someone else’s utility.

Now, let us get down to brass tacks with my sole contention.

C1: Informed Consent

I will frame this using three questions:

A. What risk is therein organ sales?

An organ seller must submit to surgery to remove an organ and live without it. Though survival with one kidney, one lung or part of a liver is highly likely, selling an organ is not risk-free.

Kidney donors are prone to reduced kidney function and elevated protein levels in urine, a concern that may exacerbate symptoms in patients predisposed to proteinuria (many of whom are already accepted in France) and result in kidney failure. Depression and anxiety are particularly prevalent among those also under greater financial burdens.



Pro also included the heart as an organ in his definition, and live donations of those tend to result in a permanent case of death.

B: Who is most likely to be selling organs?

In the case of donations, these risks are balanced by a desire to save another life. That desire is usually interpersonal. For sellers, the balance is accomplished by financial gain, which has differential effect: someone who is financially well off and appreciates the risks would be far less likely to sell their organs. Those without sufficient education to understand these risks and those in unstable financial circumstances are far more likely to be induced by financial gain, the former because that may reduce their comprehension of those harms, and the latter because the benefit of the windfall could be perceived as outweighing the perceived harms. Both are more vulnerable to the new benefits calculus.

C: Can those people provide informed consent?

For the uneducated, no. The key word here is “informed”: “knowledge of facts and appreciation of those facts are different aspects of understanding, both of which are important to informed consent.” Whether we are talking about clinical trials, where patients also choose to subject themselves to substantial health risks, or organ sales, comprehension of the information provided will vary person-to-person, even in developed countries. And we know that this is a problem for organ donors:

“According to Dr. Javad Zargooshi, a urologist who has conducted extensive interviews and surveys with hundreds of donors from several weeks to several years after transplantation, 85 percent would choose not to donate again after having realized the adverse affects that selling a kidney would have on their lives. Most male donors, who worked as day laborers, reported they were not able to work as well after transplantation because they were ‘weak and tired’, and are thus financially worse off than they were before transplantation. Research in India demonstrates that potential donors don’t understand the ramifications of kidney donation, and are told by transplant physicians and staff that they are at very low risk for complications, since they could survive perfectly well with one kidney. Goyal also demonstrates that over 80percent of donors did not understand the function of the kidney and believed that, since they had two, one was extra. How can someone assess the potential harm to their body, when they do not completely understand the function of the organ they are selling?”

In the case of those in financial turmoil, the answer is still no. While this group can be informed, they still do not meet the standard of informed consent because economic duress undermines consent.

This is a market. Countries will compete over pricing. If one country is buying at a higher price, donors will travel to that country to get the higher price, so market forces will drive prices up. Those greater windfalls are also undue inducements. Those inducements are most tantalizing to people who are struggling financially, i.e. the poor. In a clinical trial, such an inducement is deemed undue “if it is so ‘attractive that [it can] blind prospective subjects to potential risks or impair their ability to exercise proper judgment.” Particularly if the payment is high enough to lead some to participate who “would otherwise have a profound reluctance, the offer demonstrates disrespect for their deep reservations or preferences.” Those same inducements may also lead “subjects to lie or conceal information that if known would disqualify them from enrolling or continuing as participants”, except in this case, the cost is the safety of the organ recipient. Screening processes may be insufficient to prevent these organs from being transplanted, putting patients at greater risk.

And this only engages with personal decisions. Consider that individuals can be and often are influenced by family members. Potential donors may be subject to explicit or implicit threats that are inherently coercive, but organ markets generate a substantial new incentive for coercion to explode among potential sellers. Coercion is particularly problematic among younger sellers: in countries like Canada where the age of consent to donate is 16, those donors are still dependents and thus may be subject to intense financial and psychological pressures.

And this is the best-case scenario. Non-UHC countries may be induced by this system to enter the market, resulting in far less regulated markets opening worldwide and offering legal guises for organ trafficking and transplant tourism. There are already numerous examples of these offered by enterprises in China, and regular commerce in kidneys that goes unaddressed in India, the Phillippines and Eastern European countries. This won’t change so long as transplantation can be done elsewhere cheaper and more quickly, which is why the insurance industry and doctors (in the US and Israel, respectively) have also been pushing transplant tourism. Boosts to national organ supplies will invariably boost to the international organ trade, which is fraught with abuse, fraud and coercion, leading to the deaths of donors and recipients alike. Even within countries, competition between buyers can lead to side deals, as they have in Iran, where higher rates are offered by the rich to bypass wait times for transplants creating a system where access to transplants also faces issues of distributive justice, despite the increased supply.

Ignoring the effects of remuneration on informed consent blights the medical field. Informed consent plays an essential role in safeguarding trust in medical practice, which is necessary to ensure that people seek and comply with medical advice and participate in medical research. That trust is necessary to promote health, compliance with treatment, and participation in research. “Genuinely shared decision-making based on effective informed consent must be founded on mutual trust between doctors and patients… Justice in healthcare cannot be significantly advanced in reality without a robust culture of patient–physician trust.”

It also causes irreversible harm to patient autonomy. There is no dialysis machine to feed them back their lost autonomy. A failure to obtain informed consent before proceeding does substantially more harm than refusing to comply with their wishes because it is combined with the permanent loss of an organ, thus violating not only autonomy, but personal integrity and self-ownership in a permanent manner.


I also present a counterplan that addresses supply issues and does not violate distributive justice.

CP: Reimbursement

I support a universal system that compensates donors for any related costs. “Several types of regulated models offering indirect incentives or compensation for organ donations, such as health insurance, life insurance, disability coverage, or social benefits, have been proposed to encourage organ donations in developed countries.” These would cover surgical costs, incidences of side effects, psychiatric care in cases of depression, and lost wages. In UHC countries where some of these costs are already covered, this will address any shortfalls. It also removes impediments to donation, but does not provide financial incentives, thus allowing for a greater number of donations without creating a market. This can also extend to dead persons, including offering “money for funeral expenses to families who agree to organ donations, enabling families to honor their deceased relative. Such a solution allows for honorific exchange as opposed to market exchange,” providing incentives that cover costs rather than providing excessive inducements.

Back over to Pro.
Round 2
Pro
Framework

Con comes up with an intriguing idea that supports the idea of libertarianism -- people ought to have the equality, and the rights offered to them. Firstly, notice how he implicitly concedes that our freedom to choose our body parts overcomes any human dignity arguments, so any mention of Kant's ideas would stab himself in the back. Next, he asserts our equality with zero backings in itself. "Equality" is very poorly defined -- is he arguing for communism with shared resources, which has never worked? When looking at his arguments, one still ought to think if there is a net benefit. I will argue that it is worth keeping a severe inequality if it saves lives overall. For example, let us say that even my government-sponsored $75,000 would not be enough to bring the person out of poverty. But it would not kill them either in most cases. Saving 5,000 lives from death far outweighs mere suffering. 

Informed Consent

Firstly, Con says the surgery develops kidney failure, yet his source notes that only 10 donors from 8 studies had this so-called failure, a remarkably small number compared to the patients suffering in my opening argument. Con also claims that the financial burdens are what causes the depression, yet his study highlights the reasons are far more complex, "including longer recovery, financial stressors, younger age, and moral obligation to donate may identify donors more likely to develop future depression, providing an opportunity for intervention". Not only so, but the conclusion also supports that only those with depressive problems would continue these problems further on: "the experience of a donation, often in the setting of a loved one’s illness, does not increase long-term depressive symptoms for most donors". Therefore, Con's claim falls apart.

Next, Con's source states: "No deaths occurred and no donors underwent lung transplantation during 4,000+ person-years of follow-up". Already, we see a disparity between the 5,000 death-per-year worlds and the relatively safe Pro world. So long as my framework stands, my case is strong.

Thirdly, QOL -- the big argument. At first, it seems unreasonable that at least 1/3 of people (from his own source) would have to be worse off than the rest due to their situation. But this all the more supports my giving of money. Of course, this may not be the only reward. Additional counseling and support may reduce this number. More importantly, his study says "despite the negative effect of recipient death on donor HRQOL, donors did not report “donation regret” even when recipient outcomes are poor". So clearly, even with knowing the risk, and the poor experience, they believed it was worth it. This supports my reversal of human dignity in my favor. You help out those in need, and you get a little something in return. They suffered but still did not regret it, shows that the organ market would value human dignity, heightening my stance on a moral level.

Information Problem

Con presents the problem in India that I have cursory knowledge about. Indeed, it seems that 85% regret statistic seems to disagree with his study's results. However, they complained about the difficulty in going back to work after donating the organ. The steps to solve this problem would be to focus on education so that organ donors would have more knowledge for their decision. We may also compensate by allowing people days off after donating their organs. There are also ways to focus on the staff and the delivery of the message to ensure full knowledge, with all the implications of organ donation, good and bad.

One study looks over the informed consent in the first person and notes that there are fixes to this problem. "...the stress of the consent environment can be mitigated before a potential donor is admitted through the seamless integration of OPO staff into hospital environments... . They are the only individuals, by law and by regulation, who can coordinate and advance the donation process. A positive donation culture can be achieved through an emphasis on organ donation as an integral component of end-of-life care and a commitment to employing data monitoring tools to evaluate performance and use of data for continuous quality improvement efforts".

Even the greater conversion rate from another study on "quality improvement" displays that we can sway over people better -- from 51% to 60%, a significant improvement-- and resolve the conflict of "I don't know, should I do it". All these problems are merely temporary due to the current set up and can be fixed with added policies that would only help further problems (such as donating blood, sperm, or other body parts). 

Next, Con worries that the amount of money would disrespect the person's wishes, indirectly pointing out a restriction of freedoms. Once again, his research already offers a potential solution: "Worries about undue inducement can be reduced by careful assessment of risks as well as attention to eligibility criteria and the informed and voluntary consent of research subjects". Not to mention that we don't know if money is a unique motivator for people to die on their forms. His expert also agreed that "It is unknown how often such misrepresentation occurs in clinical research and also unclear whether money is uniquely capable of inducing this kind of deception. Perhaps we should worry more about the possibility of desperate patients engaging in deception if they perceive the therapeutic intervention or agent understudy to be their best or only remaining therapeutic option". As you can see, even though there remains a slight lingering risk, it is difficult to say that the organ market is the unique problem here, or that the risk is too severe. With additional screening in place, the minimal risk makes it difficult for the patient to make reckless decisions.

Con tells us that the Stanford article on Organ donation speaks of its inherent nature to be coercive. I see no mention of "inherent", and the only mention of "coercive" is to support my argument -- that people deserve the welfare and resources, and thus the dead's organs should be transferred. I ask con to explain this. As for the living age of the donor, I cannot see the difference between a free donation and a compensated donation, thus it is not unique.

Transplant tourism. Another big point. Though his source is from WHO, even the bulletin only mentions it draws sources from multiple newspapers, rather than rigorous studies or empirical analysis. On the contrary, a strong study notes that "prohibition has pushed the organ trade further underground increasing the role of organ brokers and reducing the bargaining position of organ sellers, leaving them exposed to greater levels of exploitation". I await Con to answer how "get rid of organ markets" *lessens* the exploitation. Because as far as I have proposed, the enforcement of the legal system potentially allows everyone to know how much their organs are worth, and what they should be treated. It's similar to how illegal drugs sell for absurdly high prices in the black market because they are ILLEGAL. Rarer things sell for higher prices. If Heroin was legal worldwide, the black market benefit would be little to none due to established market price (even if health impact is controversial). By contrast, Con's world lets poor people wander into the alligator's den with no way to exterminate the criminals. Finally, Con mentions the problem of the rich getting to the organs first, but does not object to my fact that we have eliminated the waiting list nearly entirely in Iran. Con tells us "justice" is more important than life but makes no support for this.

 Reimbursement

This is interesting but different types of compensation or rewards are arguably all different kinds of benefits given by some kind of market. Let's be honest, in a real free market, you can negotiate with nearly anything, not just money. An "IOU" deal could just as much befitting towards the trade as giving you a thousand dollars. Not to mention that reimbursement arguably has the same problem with coercion. A lot of poor people wouldn't understand perfectly what health insurance or life insurance covers. 75,000$ is easy to see and easy to get an idea of what it means. Giving you the "disability coverage" just seems like a cop-out, especially if we are talking about universal health care countries, which already give health care to their citizens. I'm not seeing what Con is solving from his problems.

Conclusion
Con's restriction of freedom argument is insignificant because we can fix it. On the other hand, his counterplan offers no unique benefit over just making organ trade the entire market, supplying the poor with money to get out of poverty. 

Not only does the organ market save lives, but I have also shown that it values human dignity -- you bring attention to our need to solve the organ shortage. Regardless of the motivation, we achieved the desired result to save people and therefore managed to prove our respect for the patients. Not to mention, I resolve the black market exploitation problem.

Con
Overview:

Several times in this round, Pro suggests means to address harms that were conveniently absent from his R1 case. Pro had the opportunity to set up his full case in R1. Instead of doing that, he waited for me to point out the deficits of his case and now seeks to fix those problems. Voters should disregard these arguments and hold Pro to his opening round case as they should hold me to mine. This is especially egregious as some planks are stolen from my CP. Even if you don’t buy that this is abusive, Pro still can’t claim fiat for these, which means some countries may successfully implement these changes, some do so poorly, others not at all.


Onto rebuttals.

Framework

Pro mishandles this. The word “equal” never appears in my R1. The word “equity” did and defining it by comparison to distributive justice clarifies my position: “[equity] involves notions of exchange and [distributive justice] concerns general fairness in allocation situations.” While they denote distinct types of justice, their overlap in this case is clear: seeking fairness in the exchange of resources. All people equitably experience organ failure, so all people should equitably bear the burdens of furnishing replacements.

Compare this with Pro's case, which is entirely built on act utilitarian impacts; namely that these people are compensated and that the organs save lives. He provides little reason to prefer his impacts, each of which are problematic.

First, contrary to his third contention, there is a clear distinction between organ donation and organ sales: the latter places a monetary value on irreplaceable human parts. It doesn't matter what that value is, only how the existence of that value shifts perception. Those who can afford to live without selling an organ have priceless organs. Those who can’t let the market decide what they're worth. Pro’s case clearly fails to create an equity before a sale is even made.

Second, loss of life should not always outstrip loss of quality of life. Pro’s positive impact is restricted by the number of people who need organs, whereas mine is restricted to the number of people in poverty. The waiting list for organs in the UK is around 6000. The number in poverty there is 14 million. Pro may argue that loss of life is permanent, but a) so is the loss of an organ, b) psychological harms can and should still be considered, and c) he still incurs a loss of life. Harming informed consent destroys patient-physician trust, harming health care outcomes for the poor, leading to refusals to seek care, which can end lives. The destruction of patient autonomy, personal integrity and self-ownership also yield lasting psychological harms that could lead to depression and suicide.

C1: Informed Consent

A. What risk is there in organ sales?

All of Pro’s rebuttals are solely as mitigation. Pointing out that there are few instances of side effects and almost no deaths does not eliminate the apparent risks; it just minimizes them. Pro is not challenging the central thesis: there is a cost calculus for donors, and that cost involves their health and psychological well-being. Even if it is not real (it is, especially with heart donations), the fact that people believe it functions as a calculus. So long as that harm exists, whether actual or perceived, it functions as a permanent barrier for sales.

Pro also concedes cited instances where financial stressors increase these harms. He actually quotes where it says this in my studyfinancial stressors are a risk factor in depression. Pointing out that there are other factors does not complicate this. The resulting depression is real, regardless of duration. Pro also drops that less educated and more financially stressed donors experience worse QOL.

Still, you could buy every rebuttal here and this point still stands that there is an apparent risk to organ sales, which creates a cost calculus. Pro concedes that there is a harm and that the greater harm is felt by individuals with educational and/or financial deficits.

B. Who is more likely to be selling organs?

Pro drops this analysis. Extend the key difference between donation and selling: a person who is financially well off is not induced by financial gains. Extend my point about how educational deficits can’t be solved by just providing knowledge of the facts. Patients must appreciate and fully understand that information. Improved delivery does not solve.

As such, Pro concedes my links to these vulnerable populations. These points alone demonstrate that Pro's world harms distributive justice. He concedes the link to my framework, and thus concedes that his case links to the impacts.

C. Can those people provide informed consent?

There are multiple facets to this.

First, education.

Pro concedes that a lack of comprehension automatically yields a lack of informed consent. He drops the study showing that comprehension of information given by providers to donors will vary from person-to-person. This problem exists everywhere, and as such, any solution will barely scratch it. The India example demonstrates both this and something else that affects education: medical providers do provide bad or incomplete information. These people were given misinformation by their doctors, further upsetting patient-physician trust. Pro cannot fiat away this problem – no amount of staff shifts or improvements to the message will solve for doctors delivering information poorly.

Pro focuses on the inclusion of OPO staff, but a) this doesn't resolve the problem of a doctor providing misinformation, b) it may solve for information deficits, but not understanding deficits, c) Pro’s source only discusses mitigation of “the stress of the consent environment,” which does not apply to financial stresses because they aren’t restricted to the “consent environment”, and d) his source focuses on “end-of-life care”, meaning it doesn't apply to my points about live sellers. His subsequent study is behind a paywall, so it’s unclear what “quality improvement” is or how it helps, but achieving a greater conversion rate doesn’t show that these people are providing informed consent. Improved persuasion on the part of the health care provider =/= greater autonomy on the part of the donor/seller.

Second, financial inducements.

Effects of financial inducements

Pro argues that money isn’t “uniquely capable of inducing…deception”. Two problems. One, money is a novel personal incentive, whereas donation only generates interpersonal incentives. It’s unique to existing systems - just because other systems could include other incentives doesn't negate that. Two, it doesn’t matter if it’s unique because it still increases inducement. “Motivated by cash payments or an attractive financial package, an individual could have less interest in evaluating or understanding study details, reading the consent form, or attempting to understand the goals, purposes, and risks associated with a study.” No amount of screening solves for this.

The Stanford article spells out yet another way this can affect consent: “Family pressure may take the form of credible threats of violence, in which case the potential donor is coerced and any consent invalid.” Threats are inherently coercive. Financial incentives make said threats become more common and those threats affect live donors. Providing additional reasons for that pressure to be applied (again, this doesn’t have to be unique to sales to be a problem) also has greater impact on young donors, who are more vulnerable. That’s exploitation, plain and simple.

Further, Pro drops that countries will behave like markets, instigating price wars to get as many organs as they can. He also drops that the amount of the financial inducement can and does “blind prospective subjects to potential risks or impair their ability to exercise proper judgment.” No amount of information removes those blinders.

Effects on black markets

Pro drops that non-UHC countries will enter this market. This further drives-up costs and floods the unregulated international organ trade. Even if every UHC does a perfect job, his case provides a guise of legality that will boost illegal organ trafficking worldwide.

On transplant tourism, Pro says that flooding the market will reduce organ prices. Two problems. First, creating markets also shifts demand. Introducing a bunch of new buyers drives up competition between those markets, which raises the price. Second, legal organ markets buoy illegal markets. Pro’s own study shows that regulated markets like Egypt boost thriving black markets in the country and increase exploitation. This holds true across many studies: “Under… government-controlled outlets…illicit sources of supply would be more likely to remain or evolve to satisfy the legally unfulfilled demand.” Pro’s case facilitates their growth, giving them a veneer of authenticity they can use to bring in more donors by offering to pay more than the legal market rates paid by countries. Even if we assume wait lists disappear, the well-off will still cut side deals to bypass wait times.

Counterplan

Pro’s is non-responsive to most of my case. This is not a market system. Reimbursement for fees or losses incurred is not pay for the organ. The donor does not profit. Pro drops that this is an “honorific exchange as opposed to a market exchange.” My case recognizes that donation incurs a cost burden and corrects it. People do have resources to clarify their coverage, as with any insurance. Disability coverage isn’t necessarily universal in UHC countries, and many UHC countries still fall short on coverage of other medical necessities. If simplifying is the goal, then the bevy of information and support that they would have in my case exceeds the need to individually locate and pay out of pocket in Pro’s world. Despite Pro’s claims, single-payer markets run by the state are not free market, nor is it clear what would be negotiable in single payer systems.

Back to Pro!

Round 3
Pro
Framework

Firstly, note how Con claims his plan offers more equity but does not tell us why either. He merely claims that my case seems insufficient, without tackling my massive economic benefits and failing to outweigh my lives saved. On the other hand, Con's "justice" is the exact opposite. We ignore those in need, and we ignore the government's innate necessity to help people who are in dire straights. We reduce the people to a means to an end, and we don't know if this end is better than mine. Next, though I claim to support an Act Utilitarian framework, you will notice that even in terms of libertarian ideals, I have hidden many strong arguments for why I defeat Con even in that stance. Regardless of which values you take, Pro's plan wins out. 

Let me re-summarize what happens in a Utilitarian framework:
- The poor get out of poverty, due to awarding $50,000~75,000 to their sold organ 
- The government net benefits 7 billion, which can further be allocated to the welfare and helping the poor (ahem)
- We save 5,000 lives per year in the US alone (not to mention the 100,000 on the waiting list) while Con murders them all.

Now, what happens in a libertarian framework?
- We value our freedom to choose difficult work, even if it may harm our body. We allow ourselves to choose our paths, rather than Con telling us that this is somehow "coercive". He has failed to address my round one's final paragraph and failed to provide a solution for all hazardous work. Therefore, Pro's problems are non-unique nor truly problematic.
- We give people knowledge by telling them the government official believes the organ is worth an entire year of annual salary (US standards, at least). We prevent exploitation and lets the poor be better off than in our current world. 
- After saving the lives, we save the recipient's families from mourning and depression, countering the effects of suicide that Con had claimed.

Informed Consent

Con dropped the fact that no deaths had occurred according to his study. He dropped the fact that almost nobody regretted in the initial study he gave.

Con claims this mitigation is not enough, despite the same problems potentially existing with regular dangerous jobs. I await him to answer the difference and why the hazard is too much. Note that he dropped his kidney point. With the incredibly low chance of death (<16%, offered by his source), the idea of "they're going to die anyway" is blatantly absurd to me. Notice how Con made no differentiation from donation without compensation. If Con is correct here, nobody should donate for free. If there are a severe cost and very little benefit, then it seems more likely to me that we should give more money to increase the benefit! Under Con's logic, we would let the waiting list in hospitals stack on indefinitely, and lacking organs could rise to the number one preventative death. Con says "equity", to me, this looks like "let everyone die" as a result! And this is the ultimate loss of equity: letting disabled or sick people die in vain.

Con tries to say that the distribution will harm the poor but doesn't even tackle how the black market exploitation is linked to this. He dropped the idea that, if you are desperate enough, the poor will go with zero knowledge and be tricked into accepting a $1,000 exchange, as Con's India study demonstrates. Under my world, you may have an equal amount of knowledge, yet at the same time, you gained a year's worth of wage, so where precisely is the problem? Con doesn't know.

Education

Con concedes that "this problem exists everywhere, and as such, any solution will barely scratch it."
Con concedes that "no amount of staff shifts or improvements to the message will solve for doctors delivering information poorly."

Con offers no solution to donation without compensation. Con is giving excuses for the government to swindle the people out of their organs even worse. He wants us to offer organs for vague ideas like "social benefit". Notice how he did not explain this. What impact does it have? Does it resolve the idea of "coercion"? Is it better than outright offering $75,000? Is it better than saving the government 7 billion dollars? Ahhh, we go back to the impact analysis. Con's "equity" argument is non-unique to the current world and the pro world. Why would there be more information detriment compared to the status quo? If anything, when organ donation becomes commonplace, and thousands more are done each year, the doctors would come under greater scrutiny, and the government may be pressured into putting standards on the minimum requirement to tell the patients. 

Financial inducements

Yet once again, he offers no difference between this and dangerous jobs. Note how con goes back to information, rather than telling us it uniquely destroys the judgment of the persons. I am allowed to try to go to NASCAR Racing for great amounts of money, despite its danger. It may be the only thing I am good at, and the only way I get out of poverty. Does Con dispel my ability to do this? What about lower-wage jobs, merely to survive, on hazardous construction sites? Indeed, is Con going to somehow shut down all the jobs with financial gain and also containing a certain amount of danger? So Con wants people never to do anything where they can die or suffer great harm? Will he make it criminal for depressed people to suicide? Will he also criminalize any "dangerous sports"? It seems arbitrary that the government gets to decide for the people, and more reasonable that the people decide for themselves. Or he is going to try to enforce further exploitation by failing to pay the workers, getting rid of the "coercion", but now oppressing them for free -- like they are slaves, exactly what con wanted to avoid?! Con is now stuck in an impossible decision! This argument is contradictory and falls apart upon closer scrutiny.

Black Market

Con claims that my source says the regulated market is what caused the greater exploitation, but does not tell us where. In contrast, the summary says the prohibition pushed it further underground. To support this, the study says "Rather than targeting the alleged criminal operations of transnational crime groups and suspected ‘traffickers’, legislative action needs to focus on addressing the legal barriers and policy decisions that position individuals in positions of vulnerability, leaving them exposed to exploitation of various kinds. To do this exploitation needs to be resituated in its broader context and addressed at the domestic level where the effects of ‘criminal’ behavior are experienced. From a law enforcement perspective resources would be better served by targeting the operations of private labs and investigating the ‘organ laundering’ process."  Con misrepresented my source -- while regulated markets can be problematic, the implementation is only tricky rather than impossible. Egypt didn't know precisely what barriers existed and decisions to make. If they tackled all the problems addressed, the regulated market is not inherently problematic. 

Next, Con plucks an excerpt fitting his side, ignoring the context, further showing his bias. The full passage is "If drugs are sold openly on a commercial basis and prices are close to production and distribution costs, opportunities for illicit undercutting would appear to be rather small. Under a more restrictive regime, such as government-controlled outlets or medical prescription schemes, illicit sources of supply would be more likely to remain or evolve to satisfy the legally unfulfilled demand. " Since the market is ironically better with sold openly, synergizing with my ideals of freedom and access, my plan works in tandem to destroy Con's argument.

Con offers a final last-ditch resort that is middling at best. We do not know how bad this "side cut deal" is, and it merely seems like an alternative or small problem, rather than an over-arching issue. His article also supports the idea that regardless of morality, it cannot be exploitation -- it reaffirms that it is better than potential alternatives such as stealing or crime. It only hurts your body at your permission, and though desperate, Con does not give another method to bring the people out of poverty. I await his answer.

Counterplan

Con tries to raise his counter plan on an ethics level but misses my core point that we don't solve poverty. Besides, he drops the idea that "life insurance" is much muddier than $50,000. He doesn't solve his so-called coercion problem.

Conclusion

  • Each time Con presents a source, it offers a potential mitigation, and presents no unique harm of Organ markets.
  • Con is grasping at straws by misrepresenting sources, not only mine but his own as well. Voters should take off points for this as we go on.
  • Regardless of utilitarian or rights based arguments, I am winning the debate due to saving the poor and victims alike.
  • In pro's world, we let you choose your own path with your life, even if it may be dangerous. Even if you died, you died for what you desired. In con's world, we restrict donors for unclear reasons and let the victims die, even if they did not want to. This is no different from murder.


Con
Thank you Pro.


Pro drops my overview, thus conceding that he cannot add to his case after R1. Voters, disregard all planks he has attempted to add.

Framework Comparison

Pro’s Frameworks

Neither Pro's utilitarian framework nor his libertarian framework is examined in any detail, neither is weighed against distributive justice or equity, and both appear for the first time in R3.  Pro doesn’t provide any reason to prefer either framework, and all his benefits stem from physical gains rather than any existential benefits of liberty. His only impact under libertarianism is freedom, though its importance is inseparably linked to the view that I am somehow cancelling dangerous jobs. Pro never links this to my CP. I've given several reasons why my arguments specifically apply to organ sales, much of that in my framework; Pro has chosen to ignore them to make this false equivalence, and the series of questions he asks later in the debate aren’t an argument. At best, it's a poorly phrased slippery slope with no links to my advocacy. Meanwhile, Pro is actively hampering the independent agency of millions or even billions of people, debilitating their capacities to engage in informed consent and retain bodily autonomy. He’s using the poor and uneducated to solve an organ deficit that affects everyone. All his impacts focus on the results of their sacrifices because all he cares about is the ends, not how they are achieved. Pro talks about disregarding the needs of the people, but he’s more than willing to subvert a majority of them to the needs of a few. There is no inherent right to selling an organ for monetary gain, but the right to patient autonomy is established.

On his utilitarian impacts, Pro asserts that a one-time check that must also be used to pay for medical bills and psychiatric care will get people out of poverty. That's unlikely to cover enough to do much more than shift their tax bracket for one year, but even if it does, the resulting loss of autonomy, personal integrity and self-ownership outstrip it, resulting in permanent losses that a monetary bolus cannot address. The boon for the economy has no impacts, and it’s far too late for Pro to designate where it goes or what it would be used for. Pro’s only impact with heft is saving lives with these organs, though I outweigh it with harms to physician-patient relations. Pro tries to frame these deaths as ongoing murders, but a) the legal claim of murder requires more than just assertion that all preventable deaths fall into this category, b) this assumes total responsibility on the part of the government for every death due to organ failure, including those of heavy drinkers and smokers, and c) the deaths Pro is causing are similarly preventable and therefore also murder under his view.

Pro also presents two asides on his frameworks. Pro argues that giving people knowledge of the financial worth of their organs somehow prevents exploitation, though he doesn't support that claim. He also drops my argument that ascribing monetary value to organs shifts perceptions among poor populations, yielding psychological harms. Pro also claims to address depression resulting from these deaths, but turn that impact because he's generating a greater death toll since the relative size of those who would sell their organs is far smaller than that of the poor and uneducated, widening the scope of psychological harms when organ sales are legal.

Con’s Framework

Pro drops every reason I provide to prefer my framework. Only my framework receives any explication and definition. Extend the distinction between organ donation and sales and the importance of perception. Organ donations functionally render all organs priceless. Organ sales attach price tags. Extend that quality of life, for which Pro has no specific impacts, can outweigh loss of life. Extend that my numbers are bigger: for every 6000 people who need organs, there are 14 million in poverty, and that’s in a rich UHC country. Extend that this larger population will experience depression because of the commodification of their parts, resulting in a greater risk of suicide. Extend that the harm he does to patient-physician trust will lead to loss of life and serious health harms. By dropping these points, Pro concedes that his impacts cannot match up, and this is before I even start on my contentions.

My plan embraces distributive justice and equity, as I actively facilitate the process of organ donation by levelling the economic playfield. The costs associated with donation in the status quo prevent many individuals from donating. By addressing those costs, I make donation equitable. Pro’s plan generates a unique incentive structure to purchase organs, one that is most attractive to the poor and uneducated. This skews the burden of solving for organ deficits on them, yet organ recipients are not similarly skewed.

How do we know this? Because these links are baked into his first and second contention. Pro’s C1 concedes that this will be viewed as a means to escape poverty, which means the poor will sacrifice their autonomy in droves while the rich retain theirs. Pro’s C2 concedes that those organs solve for entire wait lists, meaning organs from the poor go to everyone (though more rapid access will still be available only to the rich). Every ounce of solvency Pro gains, every person he coerces into this system with financial remuneration, every person who even considers it as a means to escape poverty, adds greater harms to his case that exceed his impacts.

Informed Consent

Links

Anticipation outweighs regret. Pro drops that there are actual and perceived risks to organ sales and that only the poor and uneducated will shoulder those risks. Size of risk does not matter; the existence of or perception of risk is all I need to prove this link. Pro also drops that young people will be exploited via threats of physical violence and ostracism.

Impacts

Pro’s only general response to my impacts is that they are non-unique. Pro drops two responses. First, money is a unique incentive to give when it comes to organs. That incentive does not exist with donation – only a financial disincentive exists, one that my case resolves. Second, uniqueness doesn’t matter because sales still increase the number of people signing away their medical autonomy. Other existing inequities and failures of consent do not justify piling on.

Education

Pro quotes two lines I said in the previous round, arguing that these somehow show that my argument is non-unique. The prevalence of a lack of education may be non-unique, but the exploitation of that lack uniquely increases under Pro’s case. By quoting me, however, Pro concedes that he can do nothing to address this problem. Pro tries to cover for this with claims of oversight, but a) this is a new plank to Pro’s plan, b) the rush to erase the wait list will lead to lapses, and c) at best, this solves for misinformation from doctors; it cannot address a lack of understanding from the patient, resulting in continued failures to understand the risks of surgery. This alone is sufficient to grant me access to all my impacts on distributive justice, conceding my impacts on damage to patient-physician relations, loss of autonomy, and depression.

Financial Inducements

The main issue with organ sales is not the inherent dangers involved in the surgery, but rather with the use of financial incentives to prevent people from making sound medical decisions. Pro drops that cash payments affect motivations to evaluate or understand a procedure and the resulting risks. Pro drops that larger payments blind subjects and further impair judgement. This supercharges all of my impacts on distributive justice.

Black Markets

The sources here validate my points. The Egypt paper demonstrates that regulated markets are parasitized by black markets. This has “increased the role of intermediaries and reduced the bargaining position of organ sellers, leaving them exposed to a greater risk of harm.” Pro can’t present theoretical fixes (with no examples of effective implementation) and then fiat that countries will make these improvements when they create their markets. Another new plank for Pro's plan gone.

Pro can’t seem to decide what form his market will take. What Brookings shows is the differences between how a black market responds to two different kind of legal markets: one in which “drugs… sold openly on a commercial basis”(AKA a free market), and one where they are sold “under a more restrictive regime, such as government-controlled outlets” (AKA a UHC system). A UHC system is a single buyer system and therefore not an open market. Pro is thus facilitating “illicit sources of supply” by providing opportunities “to satisfy the legally unfilled demand”, including bypassing wait times as they have in Iran.

Non-UHC countries will enter this market, which may open it up. However, that just puts him in double jeopardy. Either he’s creating a highly restricted market that prevents competition and is thus preyed upon by black markets, or he’s allowing for open competition with unregulated transplant tourism markets where prices will exceed “production and distribution costs” because competition will drive them up. Pro is either facilitating black market exploitation of organ sellers or creating new and dangerous unregulated markets where they are also exploited.

Counterplan

Extend that reimbursement is not coercion because there is no profit. Extend that this is an honorific exchange, making it mutually exclusive from market-based coercion. Extend that the CP gives the poor resources to donate equitably. Extend that this assistance helps those in UHC countries. Extend that the bevy of information and support offered by my case makes things simpler than for those receiving only money by taking away the need to individually locate and individually pay providers. By dropping these points, con concedes my CP's solvency and impact.


Once more, back to Pro.
Round 4
Pro
I have known that I am not good at conclusions so I will try to re-summarize why Con's rebuttals are insufficient to defeat the market system.

Firstly, with regards to the system of utilitarian versus distributive justice. Recall round one where I established that even with one net life saved rather than killed, I could win this debate, so long as Con does not show that the restriction on the freedom is severe enough against the killing of lives. He has repeatedly failed to show precisely why the addition of the money and mitigation of risks cannot reduce organ donation to become similar to merely a dangerous jobs, as I have compared over and over again. If voters are convinced that there is no unique risk with this addition of a new job that saves lives, then it is no different than becoming a back-breaking worker at a hazardous construction site. Notice how con jumps around the "unique" idea the whole entire debate.

I will repeat it again: Why does Con allow for the poor to work at hazardous construction sites, which may or may not result in permanent injury? 

Until con addresses this, we may ignore his entire coercion argument.

Similarly, I cross apply this to the coercion system that con claims completely restricts the people's ability to choose. He refuses to break my logic and instead goes on very specific ideals on how the "regulated market" means the same thing as the restricted regime and the idea of free market. But regulated merely means enforcing rules that prohibit the coercion and enhance scrutiny. For example, regulation may mean that the government can buy the market for no less than $50,000, rather than allowing corrupt rich men to buy them for a lowly $1,000 (as seen in Con's India study). Let me remind voters that he has failed to refute my logic. The more people buy this transaction, the more knowledge they gain about their organs, and the better the people can make the decision. US's current market is very close to a free market, but can still be considered "regulated" in some ways or another. Not only so, con has also dropped my round 1 argument that we improve the organ procurement procedure, making it more safe, and reducing the problems with kidney failure. He thinks that money alone can stop people from choosing correctly; does this mean we shouldn't offer money in dangerous jobs at all? Con has failed to address this absurd logic contradiction.

Thirdly, notice how con completely drops any physical harms and instead talks about liberty. Voters ought to judge the physical impacts completely in my favor -- the kidney transplant is henceforth not as dangerous as con claims, and severely reduces the coercion factor. Imagine I didn't know I had 3% dying in a car accident. This has far less impact on "restrict my informed consent", than if kidney deaths were the majority of implants. As you can see, the "liberty" argument is extremely difficult to uphold, and con has failed to tackle the ideas that we should allow people to make dangerous choices. Con has not responded to how low the chance of death needs to be, in order for "exploitation" to not exist. He has failed to address the fact that we allow people to take on dangerous jobs for money, and that the coercion plus chance of death is uniquely damaging. Despite his huge number of those in poverty, it seems absurd that we would exploit 14 million people. Only those willing and able to fulfill the requirements would be able to be "exploited" at all. 

I will repeat my previous question from last round in a different manner:

Are we somehow "exploiting" people who may not know all the side effects of donation, doing it because of pressure from society ("honor" as Con claims), and receiving no benefit?

I.E. How does my "exploitation" differ from free donation?

Exploiting the entire population seems far worse than 14 million people to me, if doctors can never fully inform them of their decision (as Con claims). It seems all the more likely that we should give an extra compensation to make up for potential lack of knowledge of harms! At the very least, they have room to receive extra counseling for any depression or problems that con mentioned.

Fourthly, notice how Con drops the fact that his sources are double-edged. He repeatedly refers back to Stanford's article, despite it mentioning none of his arguments (where is "coercion"? Where is "young people will be exploited via threats of physical violence and ostracism"? I certainly don't see it. Voters should dismiss his arguments based on out-of-context quotes grabbed from sources that barely support his ideals. 

Fifthly, Con repeatedly fails to refute my argument that the money given to the poor will bring them out of poverty. Con claims that his system has "honor", but what good is honor when you are sick, when you are starving, when you need another way out? In the end, to support the family, doesn't the argument still come down to my idea that organ selling is far better than the alternatives? Notice how Con completely dropped this idea. Would he rather his "distributive justice" be fulfilled through allowing the poor to continuously steal from the rich? That seems far more absurd to me.

Finally, note that I drew a very interesting position throughout this entire debate. It was clarified from the fourth round, and makes it very clear the differences of my world and Con's, counter plan aside. 

In pro's world, we let you choose your own path with your life, even if it may be dangerous. The chances of dying are very low, and the effects of exploitation are less, so long as government doesn't abuse the power of regulation. If you successfully organ transplant, then you can begin a new opportunity and start a new life. Even if you died, you died for what you desired.

In con's world, we restrict donors for unclear reasons and let the victims die, even if they did not want to. This is no different from murder. Con claims that government has no obligation to encourage people to save lives, yet his counter plan clearly shows that he *does* want to solve the organ shortage problem. 

So which is it? Con may choose to drop his counter plan, in favor of possibility that we will always lack knowledge to make a correct decision -- honor or money, there is always some kind of other motivation. Yet he has no solution for dangerous jobs, which I repeatedly mentioned throughout this entire debate. Con may also raise his counter plan above his own arguments. But he still has never countered the idea that social benefit, life insurance, seem far more confusing and able to sneak in some fine print to abuse, rather than $75,000 straight up given to you. If the poor is so desperate that they will only think about the money, it seems unlikely that they will ever contribute their organs merely for the compensation of their costs ($0 net benefit).

Not to mention, that Con does not address the fact that the 7 billion dollars saved by the government (recall round 1) may be redistributed to further helping the poor (perhaps invested in some type of basic income?), destroying the majority of his claims that the poor will not receive justice. And Con resolves nothing in the end.

For all these reasons, vote for pro.
Con
I started this debate off with three questions. I’ll end it with three more.

Why is distributive justice the most important framework in this debate?

We should aim to be a just society because injustice in any form has deep and broad effects. Distributive justice regards what happens to specific subsets of the population who are often mistreated: the poor. Failures of distributive justice harm millions of people who are already hurting.

Pro has never addressed what I said in my first round: any lack of distributive justice in this market creates a permanent disparity. This effectively brands them, stamping every organ with a price tag and making their bodies vulnerable to the highest bidder. That places a huge psychological burden on the poor even if they don’t end up doing it, because they are sitting in an economic position that may force them to brand themselves anytime things get difficult until there’s nothing left to remove. This commodification is where my impacts of depression and suicide come from.

The only impact Pro has that relates to this regards poverty. Pro asserts that the amounts of money earned from organ sales would achieve this, but he furnishes no proof of it happening in Iran, gives no reason to believe it would happen elsewhere, and provides no impacts for it. He ignores the plethora of costs that come with organ sales and donations, the latter of which my CP addresses using specific redress, while his case only purports to solve for it by giving them money. In the Con world, governments play an active role in organ donation by assisting donors in recognition of the very real harms that losing an organ can cause. My CP furthers distributive justice and equity, providing actual tools that people can use to prevent and address harms. In Pro’s world, they cut you a check and send you on your way. Money alone will often fail to address these harms. Pro’s case does nothing but expand inequities and failures of justice, and no late fiat (it came up first in R3) that his economic boon may be redistributed can solve that, either.

So, let’s compare my framework with his.

Pro repeats that any loss of life is sufficient to win him this debate. That is the only reason he ever gave to support utilitarianism as a framework, yet there are deaths on both sides of this debate. Lack of available transplants is weighed against the lives that Pro puts at risk through depression and distrust of physicians. He can’t mitigate the risks of this psychological shift because it’s inherent to the introduction of a new market and inherent to the existence of poverty. Other failures of distributive justice exist. Other avenues for exploitation of the poor exist. None of this justifies additional, and yes, unique impositions like creating an organ market. Moreover, Pro dropped that there is a much larger loss of quality of life which can outweigh loss of life. Pro never contests my numbers, conceding an over 1:2000 ratio of people helped by his case (those on the wait list) to those harmed (the poor) in UHC countries. That much suffering is damning to his case. For all his claims that I am somehow “exploiting the entire population”, the harms of his case apply to the most people by far.

On libertarianism, Pro never explains why you should prefer this framework. He doesn’t even explain what makes it important. Pro clearly doesn’t care about this framework. Neither should you.

Voters, my framework is the only one that is elucidated, the only one with a solid reason to prefer, and only my arguments apply meaningfully to it. If you buy my framework, the debate is over.

Why should we care about informed consent?

Even if you don’t buy my framework, informed consent alone is reason enough to vote Con, even on Pro’s utilitarian and libertarian frameworks. Pro’s only responses to coercion throughout the debate have been to minimize the risks of organ harvesting, but he never responds to my points about perception mattering just as much as actual harm because it can still yield a lack of informed consent even if no actual harm exists. But actual harms do exist. Pro concedes that kidney donors have a non-zero risk of kidney failure, that lung donors have a non-zero risk of serious complications, that partial liver donors have substantial quality of life impacts, and that all three of these experience far worse issues, particularly with depression, when they are financially stressed. Pro can’t solve for a lack of understanding, yet he has the audacity to argue that giving people compensation somehow functions as a way to make up for a lack of knowledge about the harms they’re experiencing? This is literally my entire point: paying people off to get around issues of understanding is inherently exploitative!

At no point in this debate has Pro challenged the coercive nature of financial inducements. At no point has he challenged that parents won’t exploit their children to receive those inducements. Pro doesn't like my paraphrasing of the Stanford article? Fine: “Family pressure may take the form of credible threats of violence, in which case the potential donor is coerced and any consent invalid… family pressure that consists of the implicit threat of ostracism… that pressure may be very effective.” Coercion. Violence. Ostracism. Coercion is and remains the most important link in this debate because any coercion is an affront to libertarian principles. It is a profound loss of not vague freedom, but of bodily autonomy, which is particularly heinous because your body is the only thing you are granted at birth, regardless of location, class or race.

Yet, the entirety of Pro’s case places doctors in a position to remove that autonomy. Patients will respond negatively to their use of financial leverage to violate said autonomy. The resulting harms to patient-physician relationships risk the health and lives of untold numbers of people who lose trust in their providers. Wait lists for organs is a problem, but an abounding mistrust or even fear of medical providers is far more insidious, and those relationships may never recover.

Pro tries to compare this with taking hazardous jobs. There’s no impact for not being able to take dangerous jobs and no link to my CP that explains how I hinder access to these jobs. He just says that voters should ignore my whole argument because people also take dangerous jobs. He doesn’t engage with bodily autonomy as a distinguishing element, with the fact that this is a medical choice as well as a financial one, and instead leans into the false equivalence. He also doesn’t engage with my point that the problems with organ sales have little to do with degree of risk; the absence of informed consent, facilitated by financial inducements, disinformation and lack of understanding, is the greater problem. Financial lures can lead people to pursue dangerous activities elsewhere, yet we must still reject additions to that coercion and prevent the implementation of new violations. In this case, by not forming an organ market, we prevent catastrophic harms to informed consent. That there are other places where those harms may be perpetrated is an appalling reason to ignore this.

How does a legal market for organ sales affect other markets?

First, recall the topic: “THBT Regulated Markets for Human Organs Should be Legal in UHC Countries.” By definition, a UHC system is a single-payer market, highly regulated and controlled with a single purchaser: the government. It’s "a government-controlled outlet." By definition, it is not free market.

Second, both Brookings and Oxford demonstrate that black markets use regulated, restrictive systems parasitically, filling unmet needs by offering avenues to acquire items that are available in the legal market faster and with less oversight. This has already happened in Iran and Egypt.

Third, while this is the case for local markets, the world market will, indeed, open up. Non-UHC countries will join the market, generating huge transplant tourism hubs worldwide that compete with UHC countries for available supplies of organs.

This means that, within UHC countries, burgeoning black markets will thrive and become increasingly exploitative. On the international level, unregulated markets will quickly outpace regulated markets, becoming destinations for the rich and further reducing any degree of distributive justice that Pro could claim; not only are the poor being bilked out of their organs, but they become the least likely to get a transplant, suffering long wait times for organs that are made more readily available to those in higher tax brackets. Even if Pro's impacts are net beneficial in UHC countries, his case is certain to cause more problems in other parts of the world where there are more poor people to be exploited.

Conclusion

Voters, the answers to these questions are the ones that should direct your vote, not a random series of responses to points that were either addressed long ago and forgotten by Pro, or that Pro himself failed to elucidate. The comparison of the Pro and Con world that he provides is ludicrous. The only way the Pro world works is based on coercion and exploitation, and his utter disregard for those facets are why he’s dismissing the Con world. To claim that the government in my world is guilty of murder is laughable; Pro drops every response I gave to that absurd accusation.

The two worlds are very clear. In Pro’s world, waiting lists are eliminated by compelling the poor and uneducated with promises of riches, bolstering unregulated and illegal markets and leaving concepts of bodily autonomy and patient-physician trust broken in its wake. In Con’s world, donors are respected and supported by governments, equity and distributive justice are upheld, and informed consent is paramount. People will die in both worlds; neither of them are perfect, but only Pro's world exacerbates and explodes harms to the world's most vulnerable populations. Vote Con.