How should society allocate organs?

The Roundtable convened to discuss the ethical issues of organ allocation as we approached the end of the semester. We began by comparing the UK and US systems for allocating scarce donated organs to patients. In the United Kingdom, patients are prioritized based on the number of "quality-adjusted life years" they would gain from a transplant, while the United States maintains a waitlist for organs, giving transplants to those who have been waiting longest. While the UK system seems to be designed to maximize utility, the US system seems to value the fairness gained in a "first come, first serve" system.

The question of whether the state can or should decided whose lives are more valuable was raised. While some discussants were uncomfortable with the idea of the state defining who deserves organs, others felt this was the best way to make sure highest value was placed on life. Still others were disturbed by the thought that some patients could be automatically handed a death sentence if they were too old or sick to receive an organ. The Roundtable considered various systems in which an element of chance gave hope to the majority of patients, while making it more likely that younger patients with a better chance of recovery would receive organs.

One particularly vivid metaphor used to represent organ waitlists was a group of shoppers checking out at a grocery store. If new shoppers keep arriving and butting in front of an individual, that just isn't fair; even if many shoppers can advance more quickly, those stuck in line have a right to a chance to get through by virtue of their waiting. People value fairness out of empathy for patients and their families. Furthermore, fairness upholds the rights of the individual at the cost of utilitarianism in order to make sure no one gets completely trampled.

Designing a system for allocating organs requires a holistic consideration of our values. The two opposing values that emerged in our discussion were life and fairness. Neither value can be set aside, so each needs to be weighed and addressed in the best possible way.

Other questions arose of whether some patients should be excluded from the waitlist system based on their past actions. The Roundtable seemed to agree that those who ruined their organs because of alcohol or drug abuse deserved transplants less than those who were "struck by lightning" and were not at fault for their illness. However, this decision was more out of concern that organs be well taken care of than out of retribution. Patients who can prove sobriety should be able to get new livers.

The real tragedy for those waiting for organs is that the longer they wait, the less likely they are to survive with their new organ. It is for this reason that most members seemed to agree that the best system would be a variant of the UK "life years" system, in which length of time on the waitlist could also be a factor. Organs should be used where they can be effective, but all people should have a fair chance at getting the transplant they need to live a healthy life.

Hopefully after this thought-provoking discussion, those of us who aren't organ donors will go sign up to become ones. Or maybe it’s time to plan a YSR kidney donation event...

Should we require American Presidents to be born American?

--Is there something about being born in a country that makes you more loyal to it?--Should the political system protect the people from themselves?--Do the people in a democracy get what they deserve?--Should Arnold Schwarzenegger be allowed to run for President?

Should Constitutional law mandate that an American president be born on US soil? The roundtable probed the ways in which our existing law mandating such was pragmatic and/or symbolic, and debated whether the law was necessary or irrelevant, reasonable or fundamentally problematic. In terms of practical benefit, was the law a necessary protection or outdated and less meaningful provision? In terms of more symbolic considerations, was the law a reasonable requirement or a form of un-American unfairness?

We began by reviewing the legal intricacies of how the Constitution defines presidential eligibility. To be eligible to hold the nation’s highest office, a candidate must have resided in the U.S. for at least 14 years and not only be a U.S. citizen but one “natural-born.” Such a rule deems naturalized citizens and those born abroad to American parents ineligible.

Such a law was written into the Constitution at the time of the nation’s founding, a time when limited transportation made one’s birthplace a good indicator of where one spent most of one’s life. Yet these conditions no longer hold in today’s rapidly-globalizing world, where transport options more rapid than the boat make itinerant lifestyles much more possible and common. What, then, could the continued relevance of the law be?

The Roundtable first considered the law from a more utilitarian standpoint. What, if any, were the unique benefits brought about by having only American-born presidents? Perhaps it was a question of who could best be trusted to “faithfully execute the office of President of the United States, and … preserve, protect and defend the Constitution of the United States.” Some in the Roundtable advocated that matters of national security required an absolute dedication to American interests towards the US best found in those native-born. A president must possess an almost “irrational,” automatic, and ingrained sense of preference and loyalty towards the US not interfered with conflicting identifications with another country which even naturalized citizens may retain. Yet others argued that dedication of service to the US need not correspond to being native-born. Notably, figures such Henry Kissinger and Madeline Albright served as examples of foreign-born public servants who had dedicated themselves just as greatly as native born officials. Thus, the law could likely preclude a number of worthy individuals from being able to serve as president.

Perhaps the issue thus went beyond a question of national security and competence. Clearly the intent and meaning of the law was not just practical but also symbolic; after all, was there not something that distinguished this restriction from other requirements, such as one regarding age? Beyond questions of utility, the law related to issues of culture and tradition, even the sanctity of “Americanness.” Beyond an important governing role, the leader of the American nation holds symbolic importance and it seems to be for this reason that presidential campaigns involve close public scrutiny not just of candidates’ policy platforms, but all aspects of their lives and characters.

Indeed, the intent behind the law in question seemed to be that an American president “be American,” yet what does and should this mean today when considering presidential eligibility? Candidates themselves know well the need to prove to the electorate a sense of Americanness that the electorate looks for. Yet they most often seem to equate this with ensuring the relevance of one’s image to mainstream American culture and ability to relate to the lifestyles of the majority of Middle America. This may be little of concern in itself, yet perhaps may account for the overwhelming similarities in the backgrounds of presidents up till the present. The Roundtable then thought through a brainstormed list of factors that that could or should be used to define what is truly American. A general consensus was that a good number of factors such as religion and race might have commonly been used in the past but ought not to, and that factors such as language and culture were more ambiguous, but the factors of values and ideologies of the Constitution were the most undisputed as fundamental criteria. A Roundtabler thus firmly advocated that such core American values ought to determine true Americanness more so than considerations of culture since they have remained constant while culture constantly changes.

Given this consideration, one could argue that a law that uses criteria linked to identity and circumstances out of individual control is not strongly tied to what is most fundamentally linked to Americanness. Furthermore, such a law could be seen as rather fundamentally un-American in principle, denying equal opportunity and showing a lack of faith in the democratic process that allows voters to ultimately decide who is fit to lead. Yet, some Roundtablers who might not include such a law if hypothetically creating a new constitution made a case against removing it from our existing one. Perhaps it is worth considering the components of the Constitution as a “compounded investment,” so to say, acknowledging the inherent value of our democratically-created founding documents as tradition in itself.

What Should Determine the Value of a Human Life

(This post courtesy of Public Relations Officer Danie Monahan)

The members of the Roundtable turned its minds to one of the most difficult questions facing humanity. Does the uniqueness of life give it its value? Or is it conscious thought and self-awareness? Or does the value of life lie in the ability to form social connections through empathy? Where exactly ought we to draw the line between those we value as human and those that we don't? What causes us to make decisions about whose life is more important in situations when we don't uphold human life as the ultimate value?

Before we could effectively dive into these questions, we had to get some definitions out on the table. First of all, the Roundtable decided to try and focus on what should give life value, not what does in practice. One member pointed out that, as humans, we would surely value human life over other species simply because we are ourselves human. A "Prisoner's Dilemma of human existence" ensures that we value those who cooperate with us more than those who don't, leading to a “tit-for-tat” morality. Another member argued that we must value all human life equally because the social implications of not doing so are dire. Similarly, we value food animals less highly because we have evolved to kill them for sustenance. While these insights proved intriguing, we decided to ask how each of us should, individually, value life.

Secondly, one member volunteered the introductory psychology definition of consciousness. Consciousness requires perception and sensation, but also self-awareness and the ability to perceive relationships between the self and the environment. A classic test used to gauge the level of consciousness of animals is to determine whether they recognize themselves in a mirror.

Many roundtablers agreed that consciousness had great value, and that hurting a conscious being clearly was worse than hurting an unconscious one. Should dolphins lives consequently be valued more highly than a human infant? They are certainly more self-aware.

In the more general sense, the Roundtable discussed the unique mystery of reproduction as a source of importance for life. We cannot control how to shape a person, while for all human purposes we can accurately reproduce plants or robots. Furthermore, we value a puppy less before it becomes an irreplaceable part of a human family. On the spiritual side, the uniqueness of a human soul would be the source of life's importance. As we explored this argument, we found it would imply that fetuses, who are in our day genetically irreproduceable, would hold value for their uniqueness. However, a "metal brain" would not hold value because it was constructed according to a plan. Most members agreed that a perfect reproduction of a self-aware human brain would definitely hold as much value as a human being.

One discussant hypothesized a value system based on pain and pleasure as the ultimate evil and good. For conscious beings, we should take the moral action that maximizes pleasure and minimizes pain in a utilitarian fashion. Thus the value of life is not all-or-nothing but rather falls on a continuous scale. The lives of mentally disabled people are just as valued as the rest of us when they feel the same spectrum of emotions.

Not completely satisfied with any of the various systems proposed, the roundtable shifted discussion to the difference between the values of adults and infants. We realized that when someone runs into a burning building, they save the baby first. Why should we value infants, and even fetuses, so highly? One student thought the value of human life lay in the potential to shape one's own development and create one's own individuality. Under this definition, the value of a life is not defined at a particular moment but rather as a sum of present and potential future conditions. Another member noted that finding meaning and direction in life is crucial to human survival in a way that differentiates us from animals.

As the discussion came to a close, the general opinion seemed to approve of this last definition. However, as we finished the pepperoni pizza, we agreed it would be best to be vegetarian in order to preserve the value of all life.