Playing the God Game

[Angry Floof]

Apparently not. You rewrote what I said by inserting got their names on the list ahead of the rest instead of using my simple time of need.

In my view time of need is the time when one qualifies for transplant not when one gets one's name on a list.

Remove all judgment factors beyond time of prescription and you're view is good. Its a bit like making trades fair by forcing everyone through the same pipe rather than permitting those who can pay to get their orders taken first by taking shortcuts. Eliminate shortcuts. Eliminate money and station. Still easier than anything we think about now. I see your LOL and raise you two LOLs.

Up to a point, that is part of what already happens but it cannot be the only consideration. Blood type and size compatibility must be factored in. Distance and availability of recipient and medical facilities must be factored in. Once those are all addressed, if there are still more than one potential recipient, then it is based on who needs it most/soonest but only up to the point that the person could realistically survive surgery. Once a person becomes too sick to realistically survive surgery, they have to be (at least temporarily) removed from the list.

Exactly. There is no way to frame this in simple terms and still call it a humane or intelligent approach.

 

[fromderinside]

Apparently not. You rewrote what I said by inserting got their names on the list ahead of the rest instead of using my simple time of need.

In my view time of need is the time when one qualifies for transplant not when one gets one's name on a list.

Remove all judgment factors beyond time of prescription and you're view is good. Its a bit like making trades fair by forcing everyone through the same pipe rather than permitting those who can pay to get their orders taken first by taking shortcuts. Eliminate shortcuts. Eliminate money and station. Still easier than anything we think about now. I see your LOL and raise you two LOLs.

I stand corrected. "First come, first served" is still black and white, though, whether you calculate time on a list or time left to live or however you determine "first." This just shows that even deciding on that is not so simple.

If only it were so cut and dried, but a lot of human beings are not so comfortable with giving a liver to an alcoholic and allowing another otherwise healthy person to die, especially if that person is young, a parent, someone who has contributed to the betterment of their community, etc.

The response to this is never easy. Trying to make it easy is to oversimplify a great many factors, not to mention unique situations. Mitigating circumstances matter to people, whether a few armchair doctors agree or not.

Your points are well made. Still, limiting to physical constraints within the first come first served should b e the bottom line. All the physical hylidae and RavenSky set forth, and I include not capable or ready for surgery among the physical, can be readily cataloged and put in the decision matrix. There should be no 'well I don't want my thing to go to a n'er do well' or other social claim made to constrain the flow of organs. Eliminate money and power from the arbitrage and a lot gets easier.

Go socialism.

 

[Angry Floof]

I stand corrected. "First come, first served" is still black and white, though, whether you calculate time on a list or time left to live or however you determine "first." This just shows that even deciding on that is not so simple.

If only it were so cut and dried, but a lot of human beings are not so comfortable with giving a liver to an alcoholic and allowing another otherwise healthy person to die, especially if that person is young, a parent, someone who has contributed to the betterment of their community, etc.

The response to this is never easy. Trying to make it easy is to oversimplify a great many factors, not to mention unique situations. Mitigating circumstances matter to people, whether a few armchair doctors agree or not.

Your points are well made. Still, limiting to physical constraints within the first come first served should b e the bottom line. All the physical hylidae and RavenSky set forth, and I include not capable or ready for surgery among the physical, can be readily cataloged and put in the decision matrix. There should be no 'well I don't want my thing to go to a n'er do well' or other social claim made to constrain the flow of organs. Eliminate money and power from the arbitrage and a lot gets easier.

Go socialism.

Good thing there are professionals, doctors, and other dedicated, educated people more qualified than us to help make these decisions.

Also, people can and do will their organs to specific recipients.

 

[dystopian]

So when you said "Deciding through value judgements is hugely problematic because such judgements are entirely arbitrary.", you didn't mean what you said?

I did. You just chose to not understand it and be pedantic.

Just as an intellectual exercise, put yourself, for a moment, in the position of a person who doesn't already subscribe to your idiosyncratic views.

What you call 'idiosyncratic' I call 'the status quo'.

Do you have any idea how self-deluding what you just wrote sounds to unbelievers? How on earth do you figure the ruleset you're advocating is "non-value judgment driven"?!? It's ridiculous! The only reason driving selection of that ruleset in place of alternative rulesets is that the people who advocate it value it!

I have no such conception; since you're arguing against a strawman of your own creation.

Oh, come on! Every ruleset actively prohibits society from deciding who gets a transplant and who doesn't for "anyone, for any reason."

This is clearly not the case. It's relatively easy to go from "we can decide smokers don't get new lungs" to "we can decide [x] don't get new lungs."; it's already been decided that it's okay to decide some people aren't worthy, after all. Once you grant that base assumption, there is no fundamental reason why you can't expand that pool of 'unworthy subjects' to include other people. If, however, you do *not* accept that base assumption, you can not get there. If you state up front that the decision making process is not open to such interpretation and is determined based solely on the waiting list and immediacy, you make it impossible to deviate from that without changing the system itself.

Your own example, a ruleset that says serial killers don't get transplants, actively prohibits society from deciding a serial killer gets a transplant for any reason.

It does not, however, prohibit society from deciding that since serial killers don't get transplants, neither do pickpockets. And once society's decided that pickpockets don't get transplants, it can decide homeless people don't. Etc, etc.

So what?

So that's the very definition of egalitarianism.

In the alternate scenario, serial killers and non-serial killers are regarded according to the exact same "No serial killers" criterion. Being judged by the same criterion is not the same thing as being treated the same.

You're just being pedantic again.

That's utter nonsense. People do not have equal chances of receiving an organ under a 'this person will flatline in the next hour, and this person might flatline in the next 2 weeks' policy. A friend of mine has been in dialysis for years. She's low down on the transplant list and will probably die without ever getting a realistic shot at a new kidney. She's 60 and most of the people who are sick enough to get a kidney under the "sickest go first" rules are over 70.

Very well; rephrase it to 'people who are in equal *need* of a transplant have an equal chance of getting one'. Obviously your friend's immediate need isn't as great as those more sick than her. She has an equal chance of getting one compared to others in her situation; not compared to people who are in more immediate danger.

Why, because your values aren't "personal"?

Yes. If my values aren't personal, then obviously we're not talking about injecting personal values into the decision making process. Duh.

Yes, I understand the basic concept of egalitarianism. The people who value equality above competing values get to have their way; and whenever actual equality is impossible, the people who value equality above competing values get to choose which of the alternatives to equality we'll all be required to use as a stand-in for equality; and regardless of how unequal that may be, they'll get to call their choice "equal".

Nice little rant. Too bad it sounds exactly like someone complaining that his rights are being oppressed because society makes him respect the rights of others. 'What do you mean, I got to play nice with the plebs!? You're oppressing me!'

Exactly. You eliminate personal values by injecting personal values. Do you seriously expect people to just go along with that theory? How do you feel about "We had to destroy the village in order to save it."?

Strawman again.

Why on earth would anybody decide to go with your values over his own merely on account of yours being put in at the base of the process instead of being put in somewhere in the "*everywhere else*" you've eliminated them from?

Because my value that everyone ought to be treated and judged exactly the same happens to be the fucking law.

See? I do understand egalitarianism. It's exactly what I said it is. "Treating everyone the same is impossible; therefore do it my way and we'll call that treating everyone the same." Don't pee on my friend and tell her it's raining.

Anything else is playing favorites. Judging everyone the same is the the only way to approach anything resembling a fair system. In my system, any time someone loses out on an organ it's simply bad luck. In your system, it's intentional. Enough said.

 

[Bomb#20]

I did. You just chose to not understand it and be pedantic. ... You're just being pedantic again.

You appear to be trying to use "pedantic" as a Get-Out-Of-Logic-Free card.

False equivalency. In one situation society can and *does* decide who lives based on arbitrary value judgements of a person's worth. In the other situation, society follows a non-arbitrary non-value judgement driven ruleset.

Do you have any idea how self-deluding what you just wrote sounds to unbelievers? How on earth do you figure the ruleset you're advocating is "non-value judgment driven"?!? It's ridiculous! The only reason driving selection of that ruleset in place of alternative rulesets is that the people who advocate it value it!

I have no such conception; since you're arguing against a strawman of your own creation.

Dude, what you wrote is right there for everyone to see. You literally called the ruleset you're advocating "non-value judgment driven". You have no grounds for accusing me of a strawman. You're doing it as a way to duck having to justify your claim.

Oh, come on! Every ruleset actively prohibits society from deciding who gets a transplant and who doesn't for "anyone, for any reason."

This is clearly not the case. It's relatively easy to go from "we can decide smokers don't get new lungs" to "we can decide [x] don't get new lungs."; it's already been decided that it's okay to decide some people aren't worthy, after all. Once you grant that base assumption, there is no fundamental reason why you can't expand that pool of 'unworthy subjects' to include other people. If, however, you do *not* accept that base assumption, you can not get there. If you state up front that the decision making process is not open to such interpretation and is determined based solely on the waiting list and immediacy, you make it impossible to deviate from that without changing the system itself.

Changing the rules for who isn't worthy is changing the system itself. We live in democracies. Legislators can make the rules whatever they please and change them however they please. There is no "you cannot get there".

Both would-be recipients are regarded according to the exact same criteria.

So what?

So that's the very definition of egalitarianism.

No it isn't. It's "The doctrine that all people are equal and deserve equal rights and opportunities." - OED. It's trivial to regard people by the same criteria without according them equal rights or opportunities. For example, your ruleset fails to accord all people equal rights and opportunities.

Very well; rephrase it to 'people who are in equal *need* of a transplant have an equal chance of getting one'. Obviously your friend's immediate need isn't as great as those more sick than her. She has an equal chance of getting one compared to others in her situation; not compared to people who are in more immediate danger.

Whoop de do. We can favor non-alcoholics for liver transplants and still give all the alcoholics an equal chance compared to others in their situation. You're simply using an escape clause to give yourself permission to treat people unequally and call it equal. You are privileging immediate need over chronic need. My friend needs a transplant just as much as sicker people; she just needs it less quickly. Always sending her to the back of the line on that account doesn't give her an equal chance.

Why, because your values aren't "personal"?

Yes. If my values aren't personal, then obviously we're not talking about injecting personal values into the decision making process. Duh.

But your values are personal. Duh. There are no non-personal values.

Yes, I understand the basic concept of egalitarianism. The people who value equality above competing values get to have their way; and whenever actual equality is impossible, the people who value equality above competing values get to choose which of the alternatives to equality we'll all be required to use as a stand-in for equality; and regardless of how unequal that may be, they'll get to call their choice "equal".

Nice little rant. Too bad it sounds exactly like someone complaining that his rights are being oppressed because society makes him respect the rights of others. 'What do you mean, I got to play nice with the plebs!? You're oppressing me!'

No, it sounds nothing at all like that. You just made that up because I pointed out your equivocation fallacy and you have no defense.

When you treat everyone by the same standards, giving everyone an equal chance, you eliminate personal values from the equation. The only 'injecting' of personal values comes into play with the 'everyone should be treated equally' assumption at the base of the process, but it is eliminated *everywhere else*;

Exactly. You eliminate personal values by injecting personal values. Do you seriously expect people to just go along with that theory? How do you feel about "We had to destroy the village in order to save it."?

Strawman again.

Apparently "strawman" has replaced "dishonest" as your new go-to ad hominem against people who draw attention to your illogic. Once again, what you wrote is right there for everyone to see. You straight up admitted you were still injecting personal values.

Why on earth would anybody decide to go with your values over his own merely on account of yours being put in at the base of the process instead of being put in somewhere in the "*everywhere else*" you've eliminated them from?

Because my value that everyone ought to be treated and judged exactly the same happens to be the ... law.

But this is the morality forum and you're making a moral claim. "Doctor's shouldn't and aren't legally allowed to just make decisions like that." "That's the law" is not grounds for claiming "That should be the law."

In my system, any time someone loses out on an organ it's simply bad luck. In your system, it's intentional. Enough said.

In your system you are intentionally discriminating against people with time-integrated need, in favor of people with instantaneous need.

 

[Jimmy Higgins]

Is the system so broken that enough people are squandering donated organs that the system needs to be adjusted, or is this a case of a single outrageous system that really pisses people off (rightly so), where a person squandered a precious gift?

 

[Bomb#20]

Is the system so broken that enough people are squandering donated organs that the system needs to be adjusted, or is this a case of a single outrageous system that really pisses people off (rightly so), where a person squandered a precious gift?

Here's the most informative article I've found on it.

... some studies have suggested that up to 50% of nonadherence might be attributable to an economic cause (6–9). However, despite some evolution, Medicare’s current immunosuppressive drug coverage ends 3 years after kidney transplantation...
... kidney allograft survival in the United States is similar to the survival observed in these countries at 3 years, but long-term survival rates are substantially lower (10-year survival: 58%, 56%, and 43% in Canada, the United Kingdom, and the United States, respectively).
... It is estimated that over 40,000 recipients are currently at risk for cost-related immunosuppressant nonadherence, with 1300–1500 allografts lost annually as a consequence.

Yes, I'd say it's so broken that enough people are squandering donated organs that the system needs to be adjusted. (But then, I'd say when the system itself is what's incentivizing people to squander their organs, it only takes one squandered organ to mean the system needs to be adjusted. Sure, a lot of organs get squandered because the recipient is an addict or is mentally ill or has authority issues or whatever; but absolutely anybody who is persistently put in the position of having to choose whether to buy immunosuppressants or eat will eventually choose to eat.)

 

[Jimmy Higgins]

That seems to be implying a different problem, not being able to afford drugs to sustain the transplant.

Lifetime access to immunosuppressants is essential to capture these benefits; to pay for the transplants but not the care necessary to ensure their survival is misguided and counterproductive.

So umm... were these noted changes made? $12k a year for medication, and that is the cheap stuff! Heh... death panels.

Fuck! Why do we even have our health care system as it is... whoops... falling off topic.

 

[Bomb#20]

...Why do we even have our health care system as it is... whoops... falling off topic.

As near as I can follow, Congress is wearing a suit, and the suit has several pockets with money in them, and Congress wants to pay for this, but it can't make up its mind which pocket to take the money out of.

 

[fromderinside]

.... people can and do will their organs to specific recipients.

Really a bad idea. Donors nor providers should make winner choices all other things being equal or accounted.