“There Will Be Blood” — The Ethics of Compensation for Bodily Fluids
Is human blood a “public resource”? Prof. Peter Jaworski argues that your bodily fluids belong to you, and governments should let you sell them.
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– To some degree, I feel silly giving Peter an introduction here at IHS, because he’s done roughly 40 programs with IHS. We have his book right there on the wall, as one of our star faculty. Also, many of you have seen Peter’s Learning Liberty videos. There are tons of them. I was watching them as an undergraduate, and those videos ultimately gave me a nudge, if you will, to work at IHS. Peter Jaworski teaches Ethics at Georgetown University. He received his PhD from Bowling Green University and he also has an M.A. from the University of Waterloo and a Masters of Science from the London School of Economics. He’s the co-founder and vice chairman of the board of directors at the Institute for Liberal Studies as well as a recent development, he’s an adjunct scholar at the Cato Institute. So, his talk today will be on There Will Be Blood, which is such a clever title and I’m really excited to hear him speak. Without further adieu, here’s Professor Peter Jaworski.
– Thanks for that introduction, Josh. Yes, I’ve had a lot to do with the Institute for Humane Studies, and I’m grateful for everything that the Institute has done for me. I didn’t even need a sandwich to come today, although I was grateful to see that I did get a pulled chicken sandwich from Rocklands, which is delicious. The Institute for Liberal Studies in Canada is like a mirror of the IHS in Canada. That was part of the idea of the IHS. Okay, so the title of my talk is There Will Be Blood. It’s about the market in blood plasma with a specific focus on Canada. I had to make some tough decisions when I was going through this talk. I was gonna cover a lot more, but I decided in the interest of time, to narrow, to tailor, but I’ll mention along the way what else I prepared and then during the questions session you can ask me any questions you’d like. Let me begin, as I do standardly, with this. There’s an almost limitless market for books about the moral limits of markets. Okay, lost a few viewers with that. Just in the last couple of years, over the last 20 to 30 years, you’ve had Michael Walzer’s Fears of Justice. Elizabeth Anderson has this really good book, Values in Ethics and Economics. Debra Satz is one of the best, and her book Why Some Things Should Not Be For Sale came out before Michael Sandel’s book and is vastly superior to Michael Sandel’s book. Nevertheless, Michael Sandel has the most popular book on this topic called What Money Can’t Buy. When I give versions of this talk, when I talk about markets without limits, it’s this book that most people are familiar with, but our book, the book I wrote with Jason Brennan called Markets Without Limits, here it is. It’s a response to all of these people, and in particular, people like Elizabeth Anderson, Michael Walzer, and Margaret Jane Radin and a little bit of a response to Michael Sandel, as well, but he’s not the main target of our response to this literature. Like I said, that’s Margaret Jane Radin This book, Contested Commodities is also outstanding. So if you’re looking to read views on the other side, don’t read Sandel, read Debra Satz first. Read Elizabeth Anderson second. Read Margaret Jane Radin third. Uh, Michael Walzer, you can read him too if you do political theory or if you’re in political science. If you’re in political philosophy, you don’t have to. Here’s me, by the way, handing a copy of Markets Without Limits to Michael Sandel. I gave it to him as a gift. I did not charge him money for a copy of my book. Although I think it’s perfectly permissible to charge people for copies of your book. By the way, Michael Sandel and all the others think it’s perfectly fine to have a market in books that they themselves write. So here’s the thesis that all of them defend. Jay and I call it the Repugnant Market Thesis. We also call it the Anticommodification Thesis. The claim is that there are some things that are permissible to have, use, and/or exchange for free but not for money. That’s what makes this claim interesting rather than banal. It is not the thesis that there are some things that money shouldn’t buy because that thesis would be boring, right? It would be boring for the same reason that a book about the moral limits of hats would be boring if it said something like the following. It established first that lying is morally wrong. Premise two was lying and wearing a hat is wrong. Therefore, conclusion, here’s a situation where you shouldn’t be wearing a hat. It follows automatically and boringly. Similarly in this debate, a lot of people talk about, for example, slavery and assassination. But of course those things are wrong independently of the question of markets and money and commodification. It would be wrong to give a gift of slaves to someone. It would be wrong to shoot a stranger as a birthday present for someone, right? Like, oh, happy birthday. I killed so and so. That would be wrong too. It’s not that money introduces wrongness into those kind of exchanges. It’s just that money tags along. So there’s an asymmetry here. G is permissible, but G plus money is not. So Jay and I defended this thesis. There are no things that are permissible to have, use, and/or exchange for free but not for money. We claim that there is no such asymmetry. That money does not introduce wrongness where none was present. So all of the things that are moral limits on markets, as far as Jay and I are concerned are things that we either shouldn’t have in the first place, or exchange in the first place, right? That’s our claim. Markets are morally neutral is another way of putting it. There are at least two different kinds of objections to markets, in principle and in practice objections. In principle claim that there’s something about markets, as such that make them incompatible with certain special goods and services. In practice objections, or empirical objections claim that there are certain empirical facts that make markets the wrong allocative tool for certain special goods and services. Now, in my talk today, which is on blood plasma, I’m gonna focus on these areas, or these objections, to having a market in blood plasma. And by a market in blood plasma, I just mean paying people for donating blood plasma. First, I’ll go through a little bit of history. Canada specific history, like why is this issue so hot in Canada? Because it’s extremely hot in Canada, and not just in Canada, but I think primarily in Canada. It’s much less hot here in the U.S. If I took a poll of most college students and asked them do you think it’s okay to pay people for blood plasma, most American college students would say yeah that’s perfectly fine. Similarly with sperm and eggs for reproductive gametes. If I asked American students that question, most Americans would be like, “oh, yeah, that’s fine.” In fact they’d say that’s how I paid for a lot of my college education. But if I asked that question in Canada, the response would be radically different. Because not only does Canada Not only does Canada have an interesting history when it comes to blood and blood plasma, but Canada has a pretty fierce kind of opposition to paying people for blood plasma, despite the fact that it’s legal in at least some provinces. And over and above that, in addition, it’s not legal to pay people for sperm in Canada. It’s not legal to pay people for eggs in Canada. Sperm and eggs are part of the things that we import from you. It’s primarily American sperm that makes Canadian babies when those Canadian babies are made through assisted reproduction. It’s kind of, kind of, yeah…
– [Male] They never thank us.
– And if I could just say one last thing about sperm, there used to be a market in sperm, and plenty of Canadian men that would donate sperm for money and we had enough men in Canada to supply the need domestically in Canada. And then it was made illegal in 1994, and after it was made illegal, all of the different sperm clinics closed up, save for basically one in Toronto and there are now 30 to 50 men in all of Canada that donate sperm. 30 to 50 men in all of Canada. 30 to 50 men who donate altruistically, that is without remuneration. In my mind, that’s worse, but you make your own
– judgment about that.
– So let me begin with history, then I’ll cover safety, security and then the mere commodity objection at the very end when it comes to blood and plasma. In the 1980’s, Canadians contracted a number of different diseases because of blood transfusion. About 30,000 Canadians became infected with Hep C. About 2,000 Canadians were infected with HIV, and about 8,000 Canadians died as a result of the tainted blood transfusions that they received in the 1980s. The Canadian Red Cross used to operate blood donation services in Canada. They don’t any longer and the reason why they don’t is for this reason. In 1983, it turns out, after the fact, we discovered, as it were, that the blood that Canadians were receiving in transfusions throughout the 80’s came from prisoners in the United States. In particular, from the Arkansas prison system. So these prisoners were paid for their blood donations. That blood would be sent to Canada, and that blood was transfused into Canadians. In 1993, the Toronto Hospital for Sick Children announced that there were 17 cardiac patients who were HIV positive. That’s 17 children that were diagnosed with HIV because of the transfusions that they received. When this event happened, a number of other things happened pretty quickly, year after year. So in 1993, Justice Horace Krever, this is the Krever Inquiry. He was the Supreme Court Justice. He launched a blood inquiry into the tainted blood scandal in the 1980’s. In 1994, very quickly, before the Krever Inquiry could issue its report, Quebec immediately banned the private sale of blood and plasma, so in Quebec, since 1994, it has been illegal to pay people for blood and for blood plasma, to compensate people for that. In 1994, it turned out, via the Krever Inquiry, that the Red Cross not only used prison blood, which you could anticipate would be of lower quality, meaning a higher likelihood of having viruses, bacteria, et cetera problems, right? Not only did they use that source for the blood, but they also knew that some of that blood was infected, and they transfused perfectly healthy Canadians anyways. They transfused, they used blood that they knew, given the testing that they had at the time, was infected with Hepatitis or HIV. Nevertheless, they transfused people anyways. In 1997, the Krever Report came out and made 50 recommendations about the blood system in Canada. Since that Krever Inquiry, everybody in this debate in Canada cites this as the dominant and the authoritative document on how Canada’s blood system should be run. In 1998, the Canadian Blood Services takes over the blood system from the Canadian Red Cross. The Canadian Red Cross no longer has any control over the blood system in Canada, which is different from here in the U.S., where the American Red Cross still collects blood and blood plasma and platelets and so on. In 2010, incidentally, the World Health Organization releases a guide to support 100% voluntary donation by the year 2020. So the World Health Organization says that all countries all over the world should not compensate donations of blood or blood plasma. An interesting footnote here, there are six countries that allow payment for blood plasma. Amongst them is Germany. Germany is an interesting case, because they say that they are fully in compliance with this voluntary unremunerated blood donation requirement by the WHO, or suggestion by the WHO, but they were really clever. By an act of law, they said if you pay people, and I can’t remember the specific number, but like $20, that doesn’t count as compensation. So you can pay people up to $20 in Germany, and that just doesn’t count as compensation. Why doesn’t it count as compensation? Well, because the law books say so. It’d be interesting if they increase that number in light of inflation. Why not $50 or $100 and they just put it into the books. That’s not compensation, ta-dah! Problem solved. In 2014, Canadian Plasma Resources, in 2012, announced that they were going to open up in Canada. They were going to open up blood plasma clinics where they were going to compensate people with a $25 gift card for their plasma donations. They announced that in 2012. As soon as they announced that, they said they were going to open in Ontario. As soon as they announced it, a number of different groups stepped up and said we can’t have this. Don’t you remember the Krever Inquiry that’s so important? We can’t allow this to happen. Nevertheless, Canadian Plasma Resources pushed on and announced the locations where they were going to open up the clinics. In what I think is a PR nightmare, but not a nightmare in any other respect, the locations for the CPR plasma clinics included places that were next to, I think it was a homeless shelter. Locations that weren’t the best. So they announced two locations. The Ontario government moved pretty quickly, and in 2014, they passed the Voluntary Blood Donation Act, which made it illegal to compensate people for blood plasma. Canadian Plasma Resources responded by saying, okay, we can’t operate in Ontario. So what we’ll do is we’ll move to Alberta. As soon as they announced that, the Alberta government, in 2017, now we’re talking about very recent times, banned the payment for plasma with a Voluntary Blood Donation Act of their own. Canadian Plasma Resources said okay. I guess we can’t operate in Alberta. We’ll move to British Columbia, and Saskatchewan and also New Brunswick. Well, in August of this year, the British Columbia Health Minister, Adrian Dix, he says that he doesn’t want Pay for Plasma clinics in the province of British Columbia. This is, by the way, when this issue, came across my radar. Since then, I’ve been doing what I can to stop the British Columbia government from passing this legislation, which I think is a nightmare. It’s terrible for patients. It’s terrible for the people who donate blood plasma. I think it’s awful and I think it’s bad. And I’m gonna tell you about that. These were amongst the list of recommendations that the Krever Inquiry put forward. Blood is a public resources. That was one of the claims in the Krever Inquiry. I find it strange that people find that appealing. I kind of think that claim is gross. No, my blood is mine. It’s not a public resource. I’m not suggesting that the people who think that this is true think that, therefore the government can say, well, everybody has to give 10 liters of blood per year and we all have to line up in front of a government office and once a year, give out 10 liters of blood. I’m not saying that that follows. I just think that this claim on its face is gross. And it’s gross in the same way that if we thought something like giving birth to babies is a public resource, right? We don’t think that. We think it’s her body, her choice. I think that applies in the case of blood plasma, just as surely as it does in the case of pregnancy. Second requirement, donors should not be paid. Third, safety of the blood supply system is paramount. Not important, but paramount. We are not to compromise on safety when it comes to the blood system. Access to blood and blood products should be free and universal. I also don’t find that appealing. Other people do. And then finally, sufficient blood should be collected so that importation from other countries is unnecessary. And I’m gonna comment primarily on safety and the sufficient blood supply. Part of the arguments for donors should not be paid is a claim about what gets to count as a commodity, so I’m gonna say something about that claim, as well. Now, you’ll notice, if you’ve done background work on this, that a lot of the recommendations from the Krever Inquiry follow the recommendations made by Richard Titmuss in his really famous book, The Gift Relationship, published in 1970. This has influenced the debate on the issue of blood donations and payment for blood and so on. It’s had an out-sized influence. It’s remarkably influential. Part of the claims that Titmuss made is that if you pay for blood, you are more likely to get lower quality blood and interestingly, and counterintuitively, he claimed, somewhat persuasively at the time, that if
you paid people for blood, you’ll get less of it. Now, think about that. Standard econ textbook stuff says you pay somebody for it, you get more of it, right, and if you pay them more, you’ll get even more. There’s a one to one monotonic relationship between those two things, but Titmuss argued, persuasively, that that’s not true. Consider people who are moved to donate blood out of the kindness of their hearts. So they want to do it because they regard it as their civic responsibility. For people like that, if you then say, well, I will pay you $10. Those people might then think that the signal that they’re sending, the signal of altruism, that it gets diminished and not boosted. For economists, it’s like, you have two reasons to go now. One reason is you get paid. The other reason is you were moved to do so anyways, ta-dah! It should increase blood donations by a lot. But instead, Titmuss said that those two motives might sometimes come into conflict. Then if we don’t pay people enough for their blood donations to overcome the people that drop out, because of the altruistic signal is diminished when you pay people, then we’re gonna get less blood overall. So those were his claims. So these are the things that I’ll cover. So that’s the history, let’s move on to safety. Now, we’re talking about compensating people for blood plasma donations, for the purposes of making plasma products. Protein plasma products. We’re not talking about transfusions. Those are two separate issues and it’s important to keep those two things separate. Canada is self-sufficient when it comes to blood plasma for transfusions. The tainted blood scandal, that entire crisis, was about blood plasma and blood collected for transfusions. It had nothing to do with plasma protein products. Canada is far from self-sufficient when it comes to plasma protein products. In fact, we’re about 20% sufficient. The remainder, we import from the United States. 20% of our intravenous immunoglobulin, albumin and factor VIII, we’re about 20% sufficient for that. The rest we have to import from the U.S. So here’s the claim. We ought to have the safest plasma system possible for transfusions and plasma protein products. Paid plasma is less safe than voluntary, unremunerated plasma donation for transfusions. Paid plasma is less safe than VUPD, the voluntary one, for the plasma protein products. Therefore, we ought not have paid plasma at all, right? That’s the claim. Well, it turns out that technology has moved on since the 1980’s, and the relative safety of paid plasma to unpaid plasma is about the same. Both of those are just as safe, and part of the reason why is because of the procedures that paid plasma clinics use and because of improvements in technology. So here’s a list of, this is from Octapharma. CSL and all of the other private companies, GRIFOLS, et cetera, they all use a similar process. So it begins with a donor selection pool, and you have to be in good health. You have to be over 18 years old. You have to weigh a certain amount, and importantly, you have to have a social security number, and you have to have a residence. And that residence is checked, right? So right away, a large part of the pool of people that might want to sell their plasma, who are homeless, for example, can’t participate in this process. In addition, all of the addresses are checked against known transient locations. I went to a plasma clinic and saw this process in action. So, right away, that takes care of some of it. In addition, that plasma that’s collected from your first donation, there’s a hold on it until your second donation. Some of the viral markers don’t show up until several weeks afterwards, so the plasma clinics wait until you make your second donation. When both of those go through, that is, when both of those meet the viral marker requirements, then there’s a pause on the entire pool of blood plasma donated in that clinic during that time and only if the pool, as a whole, meets an additional viral marker standard, will all of that blood plasma be released in order to be fractionated into the plasma protein products. Those are an incredible set of safety steps and precautions that they take. Some of the more recent technological changes, and the one that I want to highlight is the use of solvents and detergents that are extremely efficient against HIV, Hepatitis B and Hepatitis C. So they use new solvents and detergents. There’s now a pasteurization process that the plasma goes through. There’s nanofiltration, right, and there’s a low pH treatment, as well. All of those, combined, have made it so that safety, in effect, when it comes to plasma protein products is simply not an issue. And in fact, Canadian Blood Services themselves say the plasma industry’s experience over the last three decades, that’s 30 years, shows that drugs made from plasma donated by paid donors are as safe as those made from plasma donated by volunteer donors. CBS says so, and here’s the CEO of Canadian Blood Services, Dr. Graham Sher. He says, without mincing words, it is categorically untrue to say, in 2015 or 2016 that plasma protein products from paid donors are less safe or unsafe. They are not. They are as safe as the products that are manufactured from our, that is Canada’s, unremunerated or unpaid donors. Just as safe. Health Canada themselves weighed in on the issue. They said there has not been a single case of transmission of Hep B, Hep C or HIV caused by plasma products in Canada since the introduction of modern manufacturing practices over 25 years ago, despite the fact that most of the plasma donors were paid. An overwhelming majority, in fact, 80% are paid in the U.S. The Canadian Hemophilia Society says the same thing. They say look, these products are just as safe as the unpaid one. So the conclusion here is that paid plasma is just as safe as unpaid plasma for purposes of plasma protein products. And again, I want to reiterate, this debate is not about plasma for transfusion. It’s plasma for the making of plasma protein products. However, here’s something else that should be considered. The fact that all of the groups opposing paid plasma raise safety concerns, all of them, without exception, talk about the tainted blood scandal. They raise the concern that there might be safety issues. That people who use these medicines might be susceptible to getting HIV, HPV or HCV, right? Just raising that safety concern, when they know damn well that it’s safe, right? I think that itself is unethical. There are plenty of people who need those medicines and some of them might respond to this by saying, well, maybe I shouldn’t take this albumin. No, you should, all right. You should. You should. Just as safe. That was for the people at home. History and safety, let’s talk about security. Security, I put that in scare quotes because what we mean when we talk about security is in fact sufficiency. So the security of Canada’s blood supply is about having enough blood plasma for purposes of making plasma protein products. The claim is we ought to have a sufficient amount of safe plasma for transfusions and for plasma protein products. Paid plasma, like I said at the beginning, crowds out unpaid plasma. That’s Richard Titmuss’s claim. Given the crowding effect, we will have less plasma overall, if we pay people. Therefore, we ought not to have paid plasma. Well, okay, let’s take a look at the empirical data. In fact, Nico Lacetera at the University of Toronto and Mario Macis at Johns Hopkins University, they’ve done a series of these studies and they’ve, unsurprisingly to people in this room, they found that Richard Titmuss is simply wrong. So here’s a natural field experiment done in Northwest Ohio in cooperation with the American Red Cross, and they found that when people were informed of a reward and the reward differed from $5 to $10 to $15, more people donated blood. And what’s interesting is that the group of people who were uninformed of this new reward that they were introducing, also increased, and the reason why is because you have network effect. You don’t have to inform everybody. Somebody’s gon
na tell their neighbor. Hey listen, they’re giving out $15 T-shirts or $15 gift cards at the American Red Cross and more people would come out. This is 92,000 individuals, just this one alone. Here’s people who previously had donated at that particular site, even they were encouraged to donate more the higher the reward was. The higher the compensation, the more people donated. And here’s people who had not previously donated at the place. Similarly, we see even higher numbers amongst those people. In a separate article, here’s incentives for pro-social activities. The way that people pay people for things like blood and blood plasma can be pretty creative. You don’t have to hand them cash. You could hand them a mug that has a cash value. You hand them a T-shirt that has a cash value, but it isn’t just hard, cold cash. You can give people gift cards that are valuable. And what they found, unsurprisingly to those of us who hadn’t read Richard Titmuss, surprisingly to those of us who had, that every one of these incentives, from a mug that cost $1.74, up to a jacket that cost $9.50. As you increase the reward amounts, so the amount of pro-social activity goes up. Worried about the quality, like who’s giving the blood, you would expect to see as the reward amount goes up, you would expect, following Titmuss, to see a sharp rise in the amount of donors that have deferred. A deferred donor is someone where we don’t accept their blood donation. So we look at you, we do a physical, then we say, oh, we can’t take your blood. You either fail a demographic test, or for some other reason, it looks like your blood is not gonna be healthy enough for us. But the deferral rates stayed roughly the same. So you saw an increase in people donating, the deferral rate remains roughly the same. A slight change. Skip that one. According to Health Canada, in a 2013 backgrounder, they claim that there’s no evidence that paying plasma donors compromises the safety or weakens the country’s blood donor system. In the U.S., for example, where here it says 400, there are now over 500. I have a long list of them. There is no crowding effect. That is, the amount of people that give blood voluntarily without expecting a payment, has remained similar, despite the operation of these plasma clinics. In fact, and it’s worth pointing out. Here’s the blood donation rate per 1,000 people. This is the voluntary, unremunerated blood donation rate in these various countries. In Germany, it’s 58.1. They have a pay for plasma clinics. Austria, where it’s also legal to compensate people, 57.5. The U.S., you all know, plasma can be paid for, 56.9. Czech Republic, where it’s also legal, 39. Canada, where it’s not legal. Canada, the bastion of all that is good. The bastion of let’s help our neighbors. That’s what you think of Canada, I’m sure. Justin Trudeau is actually here, I’m assuming that this is taking time from your trip to see our prime minister ’cause he’s smokin’ hot. Canada has a rate lower than all of these countries. 36.6. Now, there’s Canadians watching. Go donate blood. You selfish fuckers. The U.S. has 80% of the world’s plasma collection clinics and is responsible for more than 70% of the entire world’s plasma protein products. The entire world’s. The entire world depends on blood plasma from U.S. plasma clinics. That’s shocking. Looking at this issue over time, the amount of people that need these products the three that I’ve mentioned, Factor VIII, albumin, and intravenous immunoglobulin, is increasing and it’s increasing pretty rapidly. The number of uses that these medicines are good for is increasing as well. There hasn’t yet been a finding of one of these drugs being useful for a disease that covers a lot of people, but it looks like something might be coming around the pipe. So albumin, for example, is being tested for its potential impact on dementia and Alzheimer’s. If that turns out to be a useful drug in the battle against Alzheimer’s and dementia, then these figures will shoot up. So of course, Canada imports blood plasma. Here is the Air Canada plane with your blood plasma. Conclusion with respect to security. Paid plasma is the only way of ensuring a sufficient amount of plasma for plasma protein products. It really is the only way. I’ve seen nothing that suggests otherwise. In fact, in Canada, the Canadian Blood Services, they closed down a plasma collection clinic because there just wasn’t enough Canadians that were willing to voluntarily give up their blood plasma. Demand for these products is growing, and it’ll continue to grow, so it’s morally imperative, I claim, that we follow a model that ensures the security of the supply, not just for Canada, but for the whole world, which requires compensated donors. So, that’s security, let me move on to the last claim, which is about the mere commodity thesis. Here’s Nobel Prize winner Al Roth. Al Roth says we have often found that distaste for certain kinds of transactions is a real constraint. Every bit as real as the constraints imposed by technology or by the requirements of incentives and efficiency. Oh, my favorite. Al Gore says markets in kidneys, you can apply this to blood plasma too, would make the poor a source of spare parts for the rich. Here is, in effect, the mere commodity thesis laid out step by step. The claim is that blood plasma is not a mere commodity. It’s somehow more special than that. It’s part of us. It’s part of our body. It’s super special. And if you think that you should regard your body as a temple, then you will think that thinking of your blood plasma like a commodity, like something that you can just sell, might clash with your moral views. So to buy or sell plasma necessarily means that you regard plasma as a mere commodity. That necessarily part is really vital. It’s really crucial. It is wrong to regard plasma as a mere commodity. Therefore, we ought not have paid plasma. That’s the conclusion of that argument. And here’s Michael Sandel. He says markets don’t only allocate goods. They also express certain attitudes toward the goods being exchanged. Markets are a kind of language. When we buy and sell stuff, we’re communicating something a little bit more than merely our preferences. We are, in part, communicating our attitudes towards the things that we buy and the things that we sell. What does it take for something to count as a commodity? So first, there’s a denial of subjectivity. The commodified thing either lacks consciousness, or is something whose experience and feelings need not be taken into account. That’s perfectly appropriate when it comes to something like this cup, with this ice water, which is good. Because this cup with the ice water has no inside. It has no perspective on the world. There is no subjectivity for us to deny. It’s okay to deny its subjectivity. But it’s wrong to do that when it comes to things like cats or dogs or to people. Second, instrumentality. The commodified thing has only or mainly instrumental value and of course that’s okay when it comes to that cup. But it’s not okay when it comes to people and when it comes to pets and other special things. And then finally, fungibility. The commodified thing is replaceable with money or other objects. In fact, possessing this fungible object is the same as possessing money. So just to remind you, the claim is that when we put a price on things, the necessary effect of us doing that is for people to begin to think of the objects that have a price tag as a commodity in this sense. That’s the claim. Now let me ask you. How many of you have one of these? Nice and high, hands in the air, please. Okay. And how many of you have one of these? And how many of you have this attitude? towards your cat or dog. Now let me ask you the following question. How many of you purchased your cat or dog at a pet store? What do you have? What do you have?
– [Audience Member] A cat.
– A cat? What’s your cat’s name?
– [Peter] What is it?
– Bumblebee? Oh, I thought you said baboobie. Bumblebee? You couldn’t give your cat a proper name? Like Richard? Richard is a dignified name. Bumblebee? This is my cat, by the way. This is Howard. Howard is a proper name for a cat. Our other cat is named Winston, which is also a proper name. This one’s name is not Bumblebee. It’s not Boobabee, either. It has a proper name, Howard. Also, Howard is a female cat. Don’t push your gender norms on my cat. My cat will be named Howard if she wants to. Bumblebee, how much did you pay for Bumblebee?
– [Audience Member] I don’t remember. Probably close to $100.
– Have you ever taken Bumblebee to the vet? How old is Bumblebee?
– [Audience Member] Seven?
– Seven years old. What was the last thing that Bumblebee went to the vet for?
– [Audience Member] Probably just a check up.
– Just a check up? Has there ever been anything wrong with Bumblebee?
– [Audience Member] No.
– Oh, okay.
– [Audience Member] But there have been annual check ups.
– Okay, okay. Who else has a cat or a dog? Yeah, Jean, what do you have?
– [Jean] I have a dog.
– You have a dog. How did you acquire your dog?
– [Jean] I paid a breeder a few grand for her.
– What’s your dog’s name?
– [Jean] Moxie.
– Moxie. How old is Moxie?
– [Jean] A year and a half.
– Oh, Moxie’s brand new. Anybody else get a cat or a dog from a breeder? What do you have?
– [Audience Member] A dog.
– A dog? How old is your dog?
– [Audience Member] Eight and a half.
– Eight and a half years old. How much did you pay the breeder for your dog?
– [Audience Member] Less than a few grand.
– What’s your dog’s name?
– What is it?
– [Audience Member] Brimmy.
– With a B?
– [Audience Member] Brimmy, yeah. Good cajun name.
– Oh, okay, good, all right fine. Brimmy, a good… Okay, Brimmy, and how old is Brimmy again?
– [Audience Member] Eight and a half.
– Eight and a half? And how much did you pay?
– You don’t remember, but–
– [Audience Member] 500.
– About 500 bucks? Eight and a half. Have you ever taken Brimmy to the vet?
– [Audience Member] Yes.
– And what’s wrong with Brimmy?
– [Audience Member] I hope nothing.
– Oh so Brimmy has never had–
– Allergies, I guess.
– [Audience Member] Hot spots that dogs get when they scratch out their fur, things like that.
– Oh, no. Brimmy scratches out his fur?
– [Audience Member] It’s common in dogs. It’s like allergy reactions.
– Okay and how much did it cost to take Brimmy to the vet and to fix this allergy problem?
– [Audience Member] Probably $50.
– $50? So 10% of the cost of Brimmy? Question, have you ever considered replacing eight year old Brimmy with a brand new $500 Brimmy? One that isn’t broken? One that doesn’t have the allergy problem that you alluded to.
– [Audience Member] Not at all.
– Not at all? You’ve never considered?
– You could get like–
– [Audience Member] Maybe if Brimmy were a cat.
– What kind of dog is Brimmy?
– [Audience Member] He’s a corgi.
– Oh, he’s a corgi? How is that not like a cat? For purposes of replacement… I was with you.
– [Audience Member] Corgis are medium dogs, not small dogs. Only small dog are like cats.
– Medium, so you say.
– [Audience Member] Yeah, chihuahuas, you know.
– Look, there’s like dogs and then there’s rodents… Look at this dog. You could take allergy suffering, broken Brimmy, get rid of him and replace him with a brand new model, but you wouldn’t?
– [Audience Member] Of course not.
– And why not?
– [Audience Member] Because I love my dog.
– You love your dog?
– I’m like that guy.
– You’re like this guy. You love the dog, despite the fact that there was a price tag on your dog. Do you know what I do when my car breaks down? I look at the cost of repairing the car and then I think about a replacement. Do you know what I do when my cats break down? Do you know what my wife does when the cats break down? She does not look at the cost of replacement. My wife fixes the problem. And the reason why is because she thinks of the cats as members of our family. So do I, actually. We both think of the cats as members of our family. Same is true of Brimmy. Same is true of Moxie. Same is true of Bumblebee, right? Even the suggestion that you would replace Brimmy with a cuter model is funny, but it’s also offensive if I were serious. You’re laughing because you know that I’m not being serious and this highlights the fact that there are at least two different senses of the word commodity. The first is just anything that is bought and sold on a market is a commodity, technically speaking. You put a price tag on it, so you could refer to it as a commodity if you want to. But there’s a difference between calling something a commodity and having a commodification attitude towards that thing. The commodification attitude is the attitude where we deny subjectivity, attach merely instrumental value and regard as perfectly fungible, whatever the object is. And the point is there is no necessary connection between putting a price tag on anything and the commodification attitude. The fact that you attach a monetary value to a cat or a dog does not lead anyone to have a commodification attitude towards them. In fact, you could empirically test the thesis that this based on. By looking at the people who paid for their dogs and looking at the people who did not. Who received their dogs as a gift or went to a shelter and saved a dog, and then you could ask those people what their attitudes are towards those dogs. My prediction, my hypothesis is that there would be no difference between those two. The fact that we buy cats and dogs at a pet store doesn’t result in anybody having bad or the wrong attitudes towards their cats or their dogs. They are still as likely to think of them as members of their family. In fact you can do that with works of art, as well. Even though museums have a clever name for it. They call it deaccession when they sell, which is effectively what they’re doing. When they sell artwork, they don’t call it selling artwork, because that implies that they think of the art as a mere commodity. Instead, they use their own fancy name for it, which is deaccession. For those of us that are not in the art world, what they’re doing is they’re selling art, okay? For those of you in the art world, I understand, I understand. It’s not selling, it’s deaccession. People might buy and sell works of art, and yet many of them have the right attitude towards that work of art. Conclusion, there is no necessary connection between buying and selling anything at all and any mode of valuation, including the commodification attitude. Buying a cat doesn’t mean that you have that attitude. Buying art doesn’t mean you have that attitude, but you might wonder. This is about the attitude that you and I have when we walk into the store or when we walk into the art auction to buy or sell art. That might be true of us inside, but consider all of the people who are watching our attitude. We might be expressing something offensive to them. Namely, we might be expressing a bad moral attitude towards those things. We might be saying, in effect of our actions, that we think of that thing as a commodity, even though inside of our own heads, that’s not true. So paying for plasma, you might think, expresses the commodification attitude, even if nobody actually has that attitude. This expression occurs independently of any attitudes the buyer or seller may have towards that plasma. Expressing the commodification attitude is wrong, therefore, we ought not to have paid plasma. Let me tell you a story about King Darius, who ruled the Persian Empire. King Darius was very curious about the way different peoples in his kingdom practiced funerals or had funerals. And so he said one day, he said, “my people respect their fathers. “We all want to publicly signal our respect. “But the Greeks do different things from the Callatians. “I will bring them both here “and I will ask them about their practices.” And so he brought forth the Greeks, and he said, “Greeks, you respect your fathers.” And the Greeks nodded very quickly. “Yes of course, King Darius, we respect our fathers.” “Tell me, how do you demonstrate that respect at a funeral?” And the Greeks sort of looked at each other, confused. They scratched their heads and they said, “well, King Darius, duh. “Why we burn our fathers on a funeral pyre. “Doesn’t everybody? “Funeral pyres signal, obviously, respect for the dead. “After all, a funeral pyre releases their souls “into the afterlife.” Now, you might be thinking to yourself, because you’re not used to this practice, you might say oh, that’s weird. Why would they burn their dead? But I’ll ask you to just think about the following. Picture someone that matters to you over here and they are deceased, I’m sorry to say. Okay, they are deceased and now picture flames. And now, put this deceased person on the flames and what’s the first word that pops into your head? First word. Just shout it out.
– [Audience Member] Barbecue.
– No, not barbecue.
– [Audience Member] Cremation.
– [Audience Member] Cremation.
– Okay, good, that’s like a synonym for this thing. But surely that’s not the first word that pops into your head. What’s the first word? Think about it. Dead body, fire
– [Audience Member] Sizzle.
– Awkward, awkward.
– [Audience Member] Respect.
– Oh, ding ding ding! Person, fire, respect! Right? Obviously? King Darius pressed on and he asked the Greeks. He said, “Greeks, would you ever consider “eating your dead fathers?” and the Greeks were outraged. In fact, they were morally offended and they said to King Darius, they said, “King Darius, that idea is morally disgusting to us. “To eat them just would be to disrespect them. “It would treat them as mere food. “Do you know what else we eat? “We eat broccoli and some of us indeed eat peas.” Gross. “It would corrupt the very meaning of funerals.” Okay, King Darius was satisfied with that. He brought forward the Callatians and he said, “Callatians, you respect your fathers?” and the Callatians nodded. Of course, King Darius, we respect our fathers. “Tell me,” said King Darius, “how do you demonstrate that respect at a funeral?” Much like the Greeks before them, the Callatians sort of scratched their heads. They were confused and they said, “why, King Darius, “why, we eat the hearts of our dead fathers. “Doesn’t literally everybody? “I mean, after all, eating the heart of your father “signals respect for the dead because after all, “when you eat your dead father’s heart, “you keep your father with you for all times.” That might also seem like a weird practice to you, but now I ask you to picture the same thing. Now you have the heart of someone that matters to you, and here you are eating the heart of someone that matters to you. What is the first word that pops into your head?
– Respect! Obviously, right! Just picture it. Heart, eat it, heart. What other than respect could it mean for those of you that eat offal. You know, O-F-F-A-L, right? When you eat the heart of the cow, that clearly signals respect for the cow. Literally. King Darius pressed on, he said, “Callatians, “would you ever burn your father on a funeral pyre?” and the Callatians were outraged. The Callatians said, “King Darius, “that idea is repugnant to us, morally repugnant. “To burn them would be to disrespect them. “Do you know what else we burn? “We burn our garbage. “If we were to burn our dead fathers, “why we would be treating our dead fathers “like we treat our garbage. “It would be to treat them like mere trash. “It would be corrupt the very meaning of funerals.” I have another example here. That’s the story of King Darius. This is Ding Ding Mao, and she’s a funeral crier. She’s a professional funeral mourner. Her job is to attend strangers’ funerals and then to make a big show of it. To cry about the person that just passed away, that she doesn’t know. She’ll show up at a funeral and be like, oh, Richard. Howard. We miss you so much. And she’ll lie down on the floor and she’ll scream about it. That’s her job and she gets paid to do that. Now people like Michael Sandel would look at that and say oh my God, that’s morally awful. But in China, it’s perfectly appropriate. It’s perfectly okay. In fact, if you get Ding Ding Mao to cry at your funeral, that’s even more respectful. That’s even more amazing. There are other cultures where people pay funeral mourners. Like in Romania. Like in the United Kingdom. Other places, besides. You can get funeral mourners here in the U.S. too. I looked it up. It’s not that expensive. Let me kind of illustrate with two more examples. One is like, what is this? What is this?
– [Audience Member] Tie.
– This is a tie. Why am I wearing this tie? Why am I wearing this? Is it because it’s windy in here? It’s not really, right? And there are these holes in my shirt and the tie is perfect for the functional keeping me warm. Is that what the tie is for? No? Why am I wearing this tie?
– [Audience Member] Respect.
– [Male] We decided it looks professional.
– Yeah, sure. We have an agreement that this is what it is to look professional and this is supposed to be a signal of my respect for you. I didn’t go so far to wear dress shoes, but nevertheless, nevertheless, I wore a tie to signal my respect for you. And don’t worry, Christie, I won’t do this at the meeting, but I have one last symbol to share with you. This is about respect, but what does this mean? Marty, what does this mean? Is this the first time you’ve ever seen this?
– [Audience Member] It’s not respect.
– That’s correct. This is not respect, but what does this mean?
– [Audience Member] Screw you.
– I don’t know if it means screw you. I think there’s a more specific…
– word for this.
– I think some of the people in this room know exactly what this means. This is your opportunity to say it. Look, it’s your time for questions and answers.
– We’re bleeding through here.
– Fuck you.
– Use the microphone please.
– [Audience Member] It means fuck you.
– Correct! This means fuck you, right? Does it have to? Picture this. We’ve never used the middle finger before. It’s way back in the day and somebody offends you and you really want to tell them fuck you. Now take a look at your hands and tell me which is the most natural digit to communicate fuck you? Is it really this one? Does that make sense to you? No, it could’ve been other ones. This doesn’t have to mean fuck you. This is merely a convention. Of course in places where this is understood as standing in for fuck you shouldn’t do that, but notice that we can change the convention. We can make this mean something other than fuck you. We could make this mean thank you and I respect you. We could. We could have a private convention. We could test it right here and now. Like, Nigel.
– [Audience Member] Fuck you so much.
– Oh, what is the appropriate response for this? That’s right. None of these meanings are written into the fabric of the universe. There’s something else. So you can look at two different worlds. Compare these two worlds and you tell me which one is the morally good one and which is the morally bad one. Here’s our earth and we make wedding speeches. We write them ourselves, right? We buy birthday presents. That’s not immoral, that’s not wrong. We buy flowers as gifts and we buy dinner on Valentine’s Day. Now imagine Twin America with different conventions. Different customs. There, they pay for wedding speeches. They make birthday presents. They grow flowers as gifts. And they make dinner on Valentine’s Day. Here, they use the middle finger to mean fuck you. There, they use the thumb to mean fuck you. Which of these two worlds is the morally good and which is the morally bad one? Answer, neither, right? It’s a mere convention. There is nothing between these two worlds that makes the one morally good and the other morally bad. And you can picture Michael Sandel. On our world, he says things like some people buy wedding speeches, can you believe it? Don’t they know how disrespectful that is? Or you can imagine twin Sandel on Twin Earth at Twin Harvard, good reference here. Saying some people write their own wedding speeches. Can you believe it? Don’t they know how this is disrespectful? If you care about someone, you’re gonna hire a professional. You don’t get Jimmy down the block to take your wedding photos. Why would you, like an idiot, write your own wedding speech? Hire a professional if you care about that person. You can picture the reasoning. And the point here is that the meaning of market transactions, whether they signal the commodification attitude or not, is a mere convention. It’s not written into the fabric of what a market exchange is. It’s a contingent fact. It is nothing but a mere convention. It’s not immoral for us to buy and sell plasma. At best, it might be bad manners, but given what I’ve said about the importance of having a sufficient amount of blood plasma, I think we need to get over whatever conventions we think attribute the commodification attitude to blood plasma. Now, I’ve done my best in Canada and elsewhere to make it plain that we need blood plasma and we should be paying people in Canada to do it. Every time I pitched an article in Canada, I can just talk about blood plasma. In the U.S., people are really keen on talking about markets and sperm for some reason, so I’d include that too. I wrote one for the USA Today that started with Don’t end NAFTA, Canada needs your bodily fluids. Like a Doctor Strangelove reference, but five hours later, USA Today and their clicking team or their Twitter team or whatever, changed the title to Why Canada needs our sperm. That was a much more effective title for getting people to click on the link on USA Today. So that’s the mere commodity thesis and that’s the end of my talk. Thank you very much.